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Figure 2. Relapses in patients with neuromyelitis optica spectrum disorder before and after treatment with rituximab. The mean follow-up duration after RTX therapy was 4.7 years. The use of rituximab was associated with significant reduction in the mean annualized relapse rate from 4.7 to 0.5 attacks per year after treatment (P = 0.011). Six patients (75%) remained relapse-free during this period of follow up. Patient 2 suffered an attack of transverse myelitis, which occurred 4 years after the last dose of treatment due to poor compliance with maintenance oral immunosuppressants [Figure 1]. Patient 7 had a relapse five years after the last dose of rituximab therapy. This patient was on maintenance azathioprine from 2010 to 2016 when she developed transaminitis. Azathioprine was withheld, and she was on prednisolone 10 mg daily when the disease relapsed