Efficacy of rituximab in refractory RRMS. (May 2019)

• Record Type: Journal Article
• Authors: Durozard, Pierre; Maarouf, Adil; Boutiere, Clémence; Ruet, Aurelie; Brochet, Bruno; Vukusic, Sandra; Carra-Dalliere, Clarisse; Labauge, Pierre; Mathey, Guillaume; Debouverie, Marc; Papeix, Caroline; Maillart, Elisabeth; Lubetzki, Catherine; Bensa, Caroline; Gout, Olivier; Giannesini, Claire; Stankoff, Bruno; Ciron, Jonathan; Brassat, David; Pelletier, Jean; Rico Lamy, Audrey; Audoin, Bertrand
• Is Part Of: Multiple sclerosis. Volume 25:Number 6(2019)
• Page Start: 828
• Page End: 836
• Publication Date: 2019-05
• Subjects: Multiple sclerosis -- relapsing/remitting -- treatment response -- second-line treatment -- disease-modifying therapies; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458518772748
• Languages: English
• ISSNs: 1352-4585

Abstract

Objective: To investigate the efficacy of rituximab as rescue therapy in patients with relapsing-remitting multiple sclerosis (RRMS) and persistent disease activity confirmed by magnetic resonance imaging (MRI) despite immunosuppressive disease-modifying therapy (DMT). Methods: In this observational nationwide retrospective multicenter study, we first identified 351 off-label rituximab-treated patients through a cohort of 15, 984 RRMS patients. In this group, we identified patients with disease activity prior to rituximab confirmed by MRI (one or more new T2 lesion and/or gadolinium-enhancing lesion) despite immunosuppressive DMT (fingolimod, natalizumab, or mitoxantrone) with a follow-up after rituximab initiation longer than 6 months. Outcome data were collected from the French Observatory of Multiple Sclerosis (OFSEP) register and medical charts. Results: A total of 50 patients were identified. Median rituximab treatment duration was 1.1 (0.5–6.4) year. Mean annualized relapse rate significantly decreased from 0.8 during last immunosuppressive DMT to 0.18 after rituximab ( p < 0.0001). While 72% of patients showed gadolinium-enhancing lesions on the last MRI performed during last immunosuppressive DMT, 8% of them showed gadolinium-enhancing lesions on the first MRI performed 6.1 (range 1.4–18.4) months after rituximab ( p < 0.0001). Conclusion: This study provides level IV evidence that rituximab reduces clinical and MRI disease activity in patients with active RRMS despite immunosuppressive DMT.