Rituximab Monotherapy versus Rituximab and Bortezomib Combination Therapy for Treatment of Non-paraneoplastic Autoimmune Retinopathy

Purpose: to study whether rituximab and bortezomib combination therapy is more effective than rituximab monotherapy in the treatment of nonparaneoplastic autoimmune retinopathy (npair). methods: retrospective case series involving six patients with npair, taking either rituximab and bortezomib combination therapy (three cases) or rituximab monotherapy (one case and two historical patients). results: patients on both treatment regimens showed stability in most of the visual function parameters during the one year of follow-up. combination therapy resulted in improvement of scotopic combined rod and cone a-wave and b-wave amplitudes in all eyes where they were available (four eyes); however, rituximab monotherapy resulted in only two eyes with stable scotopic combined rod and cone a-wave and b-wave amplitudes, while four eyes showed a decrease in both a- and b-wave amplitudes. the average improvement in b-wave amplitude (50.7% ± 29.4% [range, 25–90%]) was higher than the average improvement in awave amplitude (35.7% ± 9.74 [range, 25–63%]). no severe adverse effects were reported. conclusion: rituximab and bortezomib combination therapy may not be more effective than rituximab monotherapy in npair patients for most of the visual function parameters; however, this combination therapy may be more effective in improving scotopic combined rod and cone a- and b-wave amplitudes. this may indicate the higher efficacy of combination therapy when there is involvement of the inner retina.