Rituximab shows disability benefits in patients with secondary progressive MS
medwireNews: Rituximab treatment may reduce and delay disability progression in patients with secondary progressive multiple sclerosis (SPMS), show findings from a comprehensive real-world cohort study.
“Therapeutic options for patients with secondary progressive multiple sclerosis are limited; however, these findings suggest that B-cell–depleting therapy may be beneficial”, say the researchers in JAMA Neurology.
Yvonne Naegelin (University Hospital Basel, Switzerland) and colleagues analysed 44 propensity-score matched pairs of patients, one of whom was receiving rituximab while the other was not.
The matching variables were age, sex, disease duration and Expanded Disability Status Scale (EDSS) score. The EDSS at baseline and after matching was an average 5.93 in patients treated with rituximab and 5.70 in those not receiving such treatment.
Over the 10 years of follow-up (average of 3.5 years in both groups), EDSS scores increased in all patients, but for those taking rituximab yearly scores were a significant 0.52 points lower, on average.
In addition, patients treated with rituximab were less likely and took longer to develop confirmed disability progression than those in the control group, with a significant hazard ratio of 0.49.
The researchers note that “only a few anti-inflammatory treatments may be associated with a beneficial outcome in patients with SPMS”, but this analysis and two other studies (EXPAND and ASCEND) indicate potential efficacy for compounds that “influence B-cell biology, albeit by different mechanisms of action”.
They continue: “The differential response to these treatments may provide clues to understanding which parts of the B-cell response are pathogenic in SPMS and which patients might benefit from such treatments.”
The team looked at different patient baseline characteristics that might influence the development of confirmed disability progression, such as treatment intensity and dose, but found no significant associations.
Nevertheless, they say the findings suggest “that patients with active disease respond better to this kind of treatment.”
Among the 60% of patients who had magnetic resonance imaging (MRI) scans available, one (12.5%) of eight patients with MRI-confirmed active disease treated with rituximab developed confirmed disability progression, compared with 12 (22.2%) of 54 patients in the rituximab-treated patient group as a whole, but the team says these results should be interpreted with caution.
They conclude that a prospective randomized clinical trial is now needed to show “a higher level of evidence” for the efficacy of rituximab in patients with SPMS.
By Lucy Piper
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