Rituximab in multiple sclerosis at general hospital level. Hellgren J, Risedal A, Källén K. Acta Neurol Scand. 2020 Jan 28. doi: 10.1111/ane.13225. [Epub ahead of print].
OBJECTIVES: The use of Rituximab (RTX) in multiple sclerosis (MS) is a rapidly increasing choice of disease modifying therapy. Efficacy outside specialized university hospital-based care is not yet systematically investigated. Our aim was to evaluate off-label RTX treatment for MS at a general hospital in Sweden.
MATERIALS AND METHODS:Subjects with definite MS with at least one rituximab infusion were eligible for inclusion in this retrospective, observational study. Effect was evaluated by monitoring clinical disability, annual relapse rate, new lesions on MRI, and safety by the incidence and severity of adverse events.
RESULTS:Among the 83 included subjects, 15 had clinical worsening of disease during the median 23.5 (1-76) months of follow-up after RTX initiation: 7/66 with relapsing-remitting multiple sclerosis (RRMS) and 8/17 with progressive subtypes (PMS). Cumulative survival without worsening was 86% in RRMS and 30% in PMS. The annual relapse rate before RTX versus follow-up dropped from 0.38 to 0.05 (p <0.00001). Subjects with new enhancing lesions on MRI during the first year before RTX initiation versus the year after dropped from 0.94 to 0.024 (p <0.00001) and was only seen in RRMS (1.05 to 0.31, p=0.00003). Adverse events were mainly mild. Thirty-six out of 53 non-infusion-related adverse events were infections, of which four were serious, including a case of pneumonia with concomitant late-onset neutropenia.
CONCLUSIONS:Rituximab was as effective and safe when given at a general hospital out-patient clinic compared to results from previous university hospital-based studies. Vigilance is required concerning severe adverse events.
Rituximab is a CD20 B cell depleting antibody and is commonly used in Sweden. It is slightly less potent than ocrelizumab. In this study 18% worsened during the observation period. This occurred in 11% of people with RRMS and 47% with progressive MS, showing that people with RRMS respond the best. The relapse rate dropped to 0.05 so one relapse every twenty years, but this comes with the price of severe infections in some people. Is this reproducible?
Rituximab in the treatment of multiple sclerosis in the Hospital District of Southwest Finland Laura Airas, Marjo Nylund, Iina Mannonen, Markus Matilainen, Marcus Sucksdorff, Eero Rissanen doi: https://doi.org/10.1101/2020.01.15.20017533
Background: There are already numerous B-cell depleting monoclonal anti-CD20 antibodies which have been used to reduce the inflammatory burden associated with multiple sclerosis (MS). We describe here our experience of treating MS-patients with B-cell depleting rituximab. Patients and methods: All MS-patients (n=72) who had received rituximab treatment for at least six months by January 2019 were identified from the patient charts at the Turku University Hospital. Information about MS disease subtype, disease severity, MR-imaging outcomes and B-cell counts were collected from the charts. Results: Rituximab was well received and well tolerated by the patients. There were no serious infusion-related side effects. The most serious adverse event that led to treatment discontinuation was neutropenia. Our study confirms the usability of rituximab treatment for MS in the Finnish health care environment. Conclusions: Off-label rituximab-treatment can be successfully used to reduce MS disease burden for the benefit of MS patients.
So yep is the answer