Treatment of multiple sclerosis with rituximab: A multicentric Italian–Swiss experience

Abstract

Background: Rituximab, an anti-CD20 monoclonal antibody leading to B lymphocyte depletion, is increasingly used as an off-label treatment option for multiple sclerosis (MS). Objective: To investigate the effectiveness and safety of rituximab in relapsing–remitting (RR) and progressive MS. Methods: This is a multicenter, retrospective study on consecutive MS patients treated off-label with rituximab in 22 Italian and 1 Swiss MS centers. Relapse rate, time to first relapse, Expanded Disability Status Scale (EDSS) progression, incidence of adverse events, and radiological outcomes from 2009 to 2019 were analyzed. Results: A total of 355/451 enrolled subjects had at least one follow-up visit and were included in the outcome analysis. Annualized relapse rate significantly decreases after rituximab initiation versus the pre-rituximab start year in RRMS (from 0.86 to 0.09, p < .0001) and in secondary-progressive (SP) MS (from 0.34 to 0.06, p < .0001) and had a slight decrease in primary-progressive (PP) MS patients (from 0.12 to 0.07, p = 0.45). After 3 years from rituximab start, the proportion of patients with a confirmed EDSS progression was 14.6% in the RRMS group, 24.7% in the SPMS group, and 41.5% in the PPMS group. No major safety concerns arose. Conclusion: Consistently with other observational studies, our data show effectiveness of rituximab in reducing disease activity in patients with MS.

BMI influences CD20 kinetics in multiple sclerosis patients treated with ocrelizumab

“…Recommended dose for ocrelizumab is 600 mg intravenous every 6 months, with a fixed schedule, independent of age and Body mass Index (BMI). Otherwise rituximab has different administration protocols, usually based on CD20 repopulation count (Zecca et al, 2019) B-cell repopulation after depletion therapy discloses high inter-and intra-individual variance. Moreover, it has been demonstrated that body surface area could influence CD19 repopulation in Multiple Sclerosis patients treated with rituximab (Ellwardt et al, 2018).…”

Tailoring B cell depletion therapy in MS according to memory B cell monitoring

“…The MS therapeutic field has been recently widened by the approval of ocrelizumab (OCR) treatment as the first anti-CD20-depleting monoclonal antibody (mAb). 1 Rituximab (RTX), a first-generation anti-CD20 mAb, has also been adopted as an off-label treatment in MS, 2 , 3 and it is currently used as standard of care therapy in some European countries. 4 The standard treatment regimen of anti-CD20 mAbs usually consists of an “induction” phase, followed by regular fixed maintenance reinfusions (usually every 6 months).…”

Ocrelizumab zur Behandlung der Multiplen Sklerose

“…Ferner lieferten zahlreiche retrospektive Analysen und eine Subgruppenanalyse Hinweise dafür, dass Rituximab sowohl effektiv bei aggressiver RMS bzw. progressiver MS sein kann [33][34][35][36][37][38][39] als auch den MS-Therapien der 1. Generation (i.e.…”