Evdoshenko E, Maslyanskiy A, Lapin S, Zaslavsky L, Dobson R, Totolian A, Skoromets A, Bar-Or A Dynamics of B-Cell Populations in CSF and Blood in Patients Treated with a Combination of Rituximab and Mitoxantrone.. ISRN Neurol. 2013;2013:748127.
Background. Mitoxantrone (MTX) and Rituximab (RTX) are successfully used for treatment of multiple sclerosis (MS) and can be combined to increase efficacy.
Objective. We used MTX, RTX, and methylprednisolone in a single combined regiment and observed patients prospectively.
Methods. We present results of observational pilot study of combined therapy of RTX and MTX in 28 patients with active MS. Therapeutic protocol consisted of two infusions within 14 days. First infusion was 1000 mg methylprednisolone (MP) IV, 1000 mg RTX IV, and 20 mg MTX IV. On day 14, 1000 mg MP IV and 1000 mg RTX IV were given. Patients were followed prospectively from 12 to 48 months.
Results and Conclusion. There were no relapses among all 28 patients during the observation period. B-cell depletion of CD19+ and CD19+/CD27+ memory B-cell subpopulation in both compartments was confirmed in all patients at 6 months. We found a more rapid reconstitution of B cells in the CSF than in the peripheral blood and longstanding depression of CD19+CD27+ memory B-cell.
Conclusion. Effectiveness of combined regimen of RTX and MTX could be related to longstanding depletion of CD19+CD27+ memory B-cell subset.
So B cell depletion is yet again shown to be effective in treating relapses, the immunology brigade think it is because you are depleting antigen presenting cells that block T cell function. Have they got it all wrong and it really is the B cell that is important or do B cell harbor a trigger for MS, such as something like a virus? Get rid of the virus and you remove the trigger.
However before you think about rushing out for some mitoxantrone read on.