Abstract
Introduction
Rituximab is considered as a potential therapeutic option in relapsing-remitting (RRMS) and progressive forms (PMS) of multiple sclerosis (MS).
Objective
To investigate the effectiveness and safety of rituximab in MS.
Patients and methods
Observational study of effectiveness (clinical and radiological) and safety of rituximab in RRMS and PMS.
Results
A total of 90 rituximab-treated patients were collected: 31 RRMS and 59 PMS All patients had an active disease despite standard treatment. The annualized relapse rate (ARR) the year before rituximab was 0.86, 53.3% of patients had gadolinium enhanced lesion, and mean Expanded Disability Status Scale (EDSS) had increased from 4.2 to 4.9. During treatment, the ARR was reduced an 88.4% (p < 0.001). A significant decrease of EDSS to 4.6 was observed (p = 0.01) after 1 year of treatment, which remained stable during the second year in both groups. There was no evidence of disease activity in 70% of total sample, 74.2% of RRMS, and 67% of the PMS patients. Infusion-related symptoms were the most prevalent side effect (18.8%) and most were mild. Three thrombotic events were detected.
Conclusion
Rituximab could be an effective and safe treatment in aggressive RRMS. Some selected PMS patients could also benefit from this treatment.
Similar content being viewed by others
References
Duddy M, Bar-Or A (2006) B-cells in multiple sclerosis. Int MS J 13:84–90
Hauser SL (2015) The Charcot Lecture|beating MS: a story of B cells, with twists and turns. Mult Scler 21:8–21. https://doi.org/10.1177/1352458514561911
Lucchinetti C, Brück W, Parisi J et al (2000) Heterogeneity of multiple sclerosis lesions: implications for the pathogenesis of demyelination. Ann Neurol 47:707–717
Serafini B, Rosicarelli B, Magliozzi R et al (2004) Detection of ectopic B-cell follicles with germinal centers in the meninges of patients with secondary progressive multiple sclerosis. Brain Pathol 14:164–174
Christensen JR, Börnsen L, Ratzer R et al (2013) Systemic inflammation in progressive multiple sclerosis involves follicular T-helper, Th17- and activated B-cells and correlates with progression. PLoS One 8:e57820. https://doi.org/10.1371/journal.pone.0057820
Boross P, Leusen JHW (2012) Mechanisms of action of CD20 antibodies. Am J Cancer Res 2:676–690
He D, Guo R, Zhang F et al. (2013) Rituximab for relapsing-remitting multiple sclerosis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009130.pub3
Castillo-Trivino T, Braithwaite D, Bacchetti P, Waubant E (2013) Rituximab in relapsing and progressive forms of multiple sclerosis: a systematic review. PLoS One 8:e66308. https://doi.org/10.1371/journal.pone.0066308
Bar-Or A, Calabresi PAJ, Arnold D et al (2008) Rituximab in relapsing-remitting multiple sclerosis: a 72-week, open-label, phase I trial. Ann Neurol 63:395–400. https://doi.org/10.1002/ana.21363
Hauser SL, Waubant E, Arnold DL et al (2008) B-cell depletion with rituximab in relapsing-remitting multiple sclerosis. N Engl J Med 358:676–688. https://doi.org/10.1056/NEJMoa0706383
Naismith RT, Piccio L, Lyons JA et al (2010) Rituximab add-on therapy for breakthrough relapsing multiple sclerosis: a 52-week phase II trial. Neurology 74:1860–1867. https://doi.org/10.1212/WNL.0b013e3181e24373
Hawker K, O’Connor P, Freedman MS et al (2009) Rituximab in patients with primary progressive multiple sclerosis: results of a randomized double-blind placebo-controlled multicenter trial. Ann Neurol 66:460–471. https://doi.org/10.1002/ana.21867
Salzer J, Svenningsson R, Alping P et al (2016) Rituximab in multiple sclerosis. Neurology 87:2074–2081. https://doi.org/10.1212/WNL.0000000000003331
Alping P, Frisell T, Novakova L et al (2016) Rituximab versus fingolimod after natalizumab in multiple sclerosis patients. Ann Neurol 79:950–958. https://doi.org/10.1002/ana.24651
Sola P, Mandrioli J, Simone AM et al (2011) Primary progressive versus relapsing-onset multiple sclerosis: presence and prognostic value of cerebrospinal fluid oligoclonal IgM. Mult Scler 17:303–311. https://doi.org/10.1177/1352458510386996
Ferraro D, Simone AM, Bedin R et al (2013) Cerebrospinal fluid oligoclonal IgM bands predict early conversion to clinically definite multiple sclerosis in patients with Clinically Isolated Syndrome. J Neuroimmunol 257:76–81. https://doi.org/10.1016/j.jneuroim.2013.01.011
Villar LM, Casanova B, Ouamara N et al (2014) Immunoglobulin M oligoclonal bands: biomarker of targetable inflammation in primary progressive multiple sclerosis. Ann Neurol 76:231–240. https://doi.org/10.1002/ana.24190
Boscá I, Magraner MJ, Coret F et al (2010) The risk of relapse after a clinically isolated syndrome is related to the pattern of oligoclonal bands. J Neuroimmunol 226:143–146. https://doi.org/10.1016/j.jneuroim.2010.05.032
Bosca I, Pascual AM, Casanova B et al (2008) Four new cases of therapy-related acute promyelocytic leukemia after mitoxantrone. Neurology 71:457–458. https://doi.org/10.1212/01.wnl.0000324422.69067.e7
van Vollenhoven RF, Fleischmann RM, Furst DE et al (2015) Longterm safety of rituximab: final report of the rheumatoid arthritis global clinical trial program over 11 years. J Rheumatol 42:1761–1766. https://doi.org/10.3899/jrheum.150051
Sikkema T, Schuiling WJ, Hoogendoorn M (2013) Progressive multifocal leukoencephalopathy during treatment with rituximab and CHOP chemotherapy in a patient with a diffuse large B-cell lymphoma. BMJ Case Rep. https://doi.org/10.1136/bcr-2012-008142
Clifford DB, Ances B, Costello C et al (2011) Rituximab-associated progressive multifocal leukoencephalopathy in rheumatoid arthritis. Arch Neurol 68:1156–1164. https://doi.org/10.1001/archneurol.2011.103
Dada R, Zekri J, Ramal B, Ahmad K Acute jugular vein thrombosis during rituximab administration: review of the literature. J Oncol Pharm Pract 22:165–169. https://doi.org/10.1177/1078155214543278
Montalban X, Hauser SL, Kappos L et al (2017) Ocrelizumab versus placebo in primary progressive multiple sclerosis. N Engl J Med 376:209–220. https://doi.org/10.1056/NEJMoa1606468
Martínez-Yélamos S, Martínez-Yélamos A, Martín Ozaeta G et al (2006) Regression to the mean in multiple sclerosis. Mult Scler 12:826–829. https://doi.org/10.1177/1352458506070820
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Ethical standard
All patients included in the study acceded to donate and signed a specific informed consent and all research was conducted following legal and ethical requirements at the Research Institute of the Hospital La Fe and was approved by its Institutional Review Board.
Rights and permissions
About this article
Cite this article
Alcalá, C., Gascón, F., Pérez-Miralles, F. et al. Efficacy and safety of rituximab in relapsing and progressive multiple sclerosis: a hospital-based study. J Neurol 265, 1690–1697 (2018). https://doi.org/10.1007/s00415-018-8899-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-018-8899-3