Although this is not MS, This work points to a more limited need for dosing


Tahara M, Oeda T, Okada K, Ochi K, Maruyama H, Fukaura H, Nomura K, Shimizu Y, Nakashima I, Misu T, Umemura A, Yamamoto K, Sawada H. Compassionate open-label use of rituximab following a randomised clinical trial against neuromyelitis optica (RIN-2 study): B cell monitoring-based administration. Mult Scler Relat Disord. 2022 Mar 7;60:103730.


The aim of the RIN-2 study was a compassionate use of rituximab (RTX) for patients who completed the RIN-1 study, a multicentre, randomised, double-blind, placebo-controlled trial of RTX. We also investigated the long-term safety and efficacy of RTX.


A study design was a prospective open-label extension study following the RIN-1 study. RTX was infused repeatedly under monthly monitoring of CD19-positive and CD 20-positive B cell lymphocyte subsets from 24 weeks after an infusion.


Thirty-three (87%) of 38 patients of the RIN-1 study were enrolled from February 2016 to March 2019 at six sites in Japan. In RIN-2, RTX was administered three times (median, range 1–5 times), and the interval of RTX administrations were 9.5 [2.5] months (mean [SD]). The observation period was 20.5 [10.1] months. During the trial, three patients dropped out due to two withdrawals and one adverse event. During the study, 28 (90%) of 31 patients were treated with RTX monotherapy. Neuromyelitis optica (NMO) relapses were observed in two patients. The annualized relapse rate (ARR) was 0.035 counts per person-years, ∼1/10th compared with 0.321 in the placebo arm of the RIN-1 study. We observed 14 severe adverse events in six (18%) and 156 adverse events, of which 135 were grade 1, 11 were grade 2 and 10 were grade 3.


Under B cell monitoring, the interval of RTX re-infusion was elongated to nine months, and NMO relapses were suppressed with 0.035 of ARR.

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  • Finally!!! What I’ve been saying for a very long time. I never was on Rituximab but was on Ocrevus. The Ocrevus was too much for my tiny self. Oh, it killed off the bcells… to like ZERO and then took forever to climb back up if at all. At my 6 month interval, according to my bloodwork, I did not need another infusion but was given one anyways. At the next 6 month interval, my bcells we’re still ZERO, I felt like it was too toxic to my body (multiple reasons) so I decided not to get that infusion. So happy I didn’t because that was during early Covid days & vaccines & the research had not yet come out on how those on Ocrevus were not developing antibodies to the Covid vaccine. These drugs should definitely be tailored to each individual’s need! Otherwise we are just causing other issues while treating the one. By the way, after the last infusion I did receive, it took a year and a half for my bcells to reach even the lowest normal level. That’s just my thought and experience.

    • Thanks for the insight. The range to get back in the triALS is somehwere between about 27 and 175 weeks middle result about 72 weeks (after 4 doses) so that is one and a quarter years

      “These drugs should definitely be tailored to each individual’s need! Otherwise we are just causing other issues while treating the one”…i AGREE BUT WILL THE NEUROS DO IT.

      • Queenbee and Mousedoctor, I think you both are so right! I do not understand the resistance to monitor B Cell levels for MS DMTs, at least in US. I recall (i think) you Queenbee, said previously that you live in one of my favorite US northern states. I’m glad you were able to be given access to b cell info for your treatment. I am located in Houston (the US south), and top notch neuro said last visit that he won’t test my B Cells for this purpose. We had friendly and Indepth discussion about it but he felt it wasn’t standard in US. I searched at time and found that Mayo Clinic website stated that in select cases it will test B cells of MS DMT immune compromised. I couldn’t refind that link to post here. But I did find lab order form to test bcells for this specific purpose.
        so unclear to me why B cells aren’t monitored as a standard protocol, especially with its implications to vaccines. Best wishes to you Queenbee to stay healthy and strong this next wave.

        • There are set panels for antibody testing CD19 is often in there but you need a differnt panel to go more in depth…it adds to costs and time and remember most neuros dont give a stuff about B cells as we have bought into the T cell dogma and some neuros say lymphocyte, lymphoshite and are not that bothered on subsets either…Ask how many check the numbers after using a depleting therapy? P.s. I dont know the answer and am sure it is 100%:-)

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