Rituximab for Multiple Sclerosis? This Researcher Says No

According to a story from Multiple Sclerosis News, one of many topics discussed at this year’s European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) was the use of the monoclonal antibody drug rituximab (marketed as Rituxan) as a treatment option for the disease. Dr. Mitchell Wallin presented arguments against the use of this medication and wrote an article a year ago that was also in opposition to its use.

About Multiple Sclerosis (MS)

Multiple sclerosis is a neurological disease which is characterized by damage to the myelin sheath, a fatty, insulating, protective covering that surrounds nerve cells and allows them to communicate effectively. Although a precise cause has not been determined, multiple sclerosis is considered an autoimmune disease, in which a certain trigger, such as an infection, may cause the immune system to mistakenly attack healthy tissue. Smoking and certain genetic variants are also considered risk factors for the disease. Symptoms include blurred vision, double vision, blindness in one eye, numbness, abnormal sensations, pain, muscle weakness, muscle spasms, difficulty speaking and swallowing, mood instability, depression, loss of coordination, and fatigue. There are a number of treatments available for the disease, but no cure. Life expectancy for patients is slightly reduced. To learn more about multiple sclerosis, click here.

Rituximab vs. Ocrelizumab

Proposals to use rituximab for multiple sclerosis are often as an alternative to another drug called ocrelizumab. Rituximab, which was first approved in 1997, has gained a reputation as being effective in a diverse array of indications, ranging from blood cancers like Waldenström’s macroglobulinemia to autoimmune disorders like pemphigus. So why not multiple sclerosis?

Dr. Wallin points out that, when compared to ocrelizumab, rituximab has more non-human components. This could increase a patient’s chance of developing antibodies against the drug. Generally, rituximab has a greater chance of triggering an immune response, such as the appearance of antibodies or an infusion site reaction. With that being said, there is a significant pool of data that demonstrates that rituximab is capable of being an effective treating for the relapsing-remitting form of multiple sclerosis. However, findings for ocrelizumab have overall been more convincing.

There are still safety concerns to take into account as well. In one study, 78 percent of patients had an infusion reaction; in another, 33.9 percent had developed anti-drug antibodies. Studies with ocrelizumab have revealed that patients are much less likely to develop antibodies. Infection risks appear to be similar for both drugs.

Rituximab does hold one major appear for patients though: it is substantially cheaper ($10,000-$20,000 annually versus $65,000). However, Dr. Wallin concludes that in terms of pure effectiveness, ocrelizumab is the better choice.


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