Effects of eculizumab and rituximab on visual function, motor function and social quality in patients with NMOSD: A comparative study

Yihan Liu^1,2,3,4Li Meng^1,2,3,4Jiyuan Li⁵Xiao Wang^1,2,3,4Xiaoman Zhang^1,2,3,4Xiangzeng Kong^1,2,3,4Yongzhi Zhang^1,2,3,4*

• ¹Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
• ²Hebei Hospital of Xuanwu Hospital Capital Medical University, Shijiazhuang, China
• ³Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, China
• ⁴Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, China
• ⁵Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China

Objective: To compare the effects of eculizumab and rituximab on visual function, motor function, and social quality of life in patients with aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (NMOSD). Methods: This retrospective study included NMOSD patients treated with eculizumab (EG, n=114) or rituximab (CG, n=114) at the Department of Neurology, First Hospital of Hebei Medical University, and the First Hospital of Shanxi Medical University between January 2018 and August 2024. Patients were followed for 6 months to assess changes in visual, motor, and social outcomes. Results: Baseline characteristics, including demographics, disease duration, AQP4-IgG status, annual recurrence rate, EDSS score, and comorbidities, were comparable between groups (P>0.05). Both groups showed gradual improvement in visual acuity after treatment (P<0.05). However, the EG demonstrated significantly better uncorrected visual acuity at 1, 3, and 6 months (P<0.001) and higher corrected visual acuity (P<0.05). Visual field defects decreased more in the EG (61.40% to 33.33%) compared with the CG (64.91% to 50.88%, P<0.05). Abnormal color vision improved in both groups, with greater reduction in the EG, though not statistically significant at 6 months (P=0.065). Motor function outcomes showed significant time, group, and interaction effects (P<0.001). The EG achieved higher Fugl-Meyer Assessment (FMA) scores and lower Modified Ashworth Scale (MAS) scores at all time points (P<0.05). Social function (SFS) improved significantly in both groups, with greater gains in the EG (P<0.001). Anxiety (HAMA) and depression (HAMD) scores decreased in both groups, but reductions were more pronounced in the EG (P<0.001). Conclusion: NMOSD significantly impairs visual, motor, and social functions. Eculizumab demonstrated superior efficacy over rituximab in improving functional outcomes and quality of life, supporting its role as an effective therapeutic option for NMOSD.