Can Rituximab Delay Disease Progression in SPMS?

A recent study sought to identify whether disability progression among patients with secondary progressive multiple sclerosis (SPMS) treated with rituximab differs from patients who have never been treated with rituximab.

"Current disease-modifying treatments target the inflammatory pathology and only indirectly the neurodegenerative pathology of the disease, and their therapeutic effects in (secondary) progressive MS have been very limited," the authors explained.

Researchers designed a retrospective cohort study that analyzed data obtained from patients with SPMS at 3 MS centers in Switzerland, Amsterdam, and the Netherlands from 2004 to 2017. In total, the study investigators enrolled 88 patients who were matched after a 1:1 propensity score that used variables including sex, age, Expanded Disability Status Scale (EDSS) score, and disease duration.

At the baseline, patients treated with rituximab had a mean disease duration of 18.2 years and mean EDSS score of 5.9. Comparatively, the control arm of the study had a mean disease duration of 19.4 years, and mean EDSS score of 5.70.

Researchers found in the covariate-adjusted analysis of the matched groups, patients with SPMS who were treated with rituximab had a “significantly lower EDSS score” during a mean follow up of 3.5 years (mean difference, —0.52; 95% CI, –0.79 to –0.26; P <.001). Additionally, the time to confirmed disability progression was significantly delayed in the rituximab-treated arm of the study (hazard ratio, 0.49; 95% CI, 0.26-0.93; P = .03).

Overall, the study authors found that patients with SPMS who were treated with rituximab had a considerably lower EDSS score for up to 10 years of follow up. Furthermore, the authors noted that the confirmed progression in the rituximab-treated arm was significantly delayed compared with the matched control group, which may suggest “that B-cell depletion by rituximab may be therapeutically beneficial in these patients.”

The authors advised that future studies should include a prospective randomized clinical trial with a better “level of evidence” is needed to confirm the efficacy of rituximab in this cohort of patients.

Reference

Naegelin Y, Naegelin P, von Felten S, et al. Association of rituximab treatment with disability progression among patients with secondary progressive multiple sclerosis. JAMA Neurol. Published online January 7, 2019. doi:10.1001/jamaneurol.2018.4239