When they stop taking Rituxan, it usually isn’t for lack of effectiveness or side effects — the reasons that lead to the discontinuation of the other drugs, according to the Karolinska Institutet researchers.
They also said that patients on Rituxan have fewer relapses and fewer new brain lesions than those on other therapies. Brain lesions are areas where the myelin sheath that cover nerve cells has deteriorated.
The team wanted to explore differences in patients’ discontinuation of Rituxan, compared with other treatments. The study covered newly diagnosed relapsing-remitting MS patients in two counties in Sweden — Västerbotten and Stockholm.
Their work, “Comparative Effectiveness of Rituximab and Other Initial Treatment Choices for Multiple Sclerosis,” appeared in the journal JAMA Neurology.
The study covered 494 patients with relapsing-remmitting MS whose median age of 34.4 years.
Rituxan was neurologists’ drug of choice as a first-line treatment for patients in Västerbotten County, which is in northern Sweden. Eighty-one percent of patients there were taking it.
In contrast, only 18 percent of patients in Stockholm County in the south were receiving Rituxan.
Treatments that other patients were taking included the injected drugs interferon beta and glatiramer acetate (sold as Copaxone and generic versions), the oral medications Gilenya (fingolimod) and Tecfidera (dimethyl fumarate), as well as the infused treatment Tysabri (natalizumab). Copaxone’s maker is Teva Neuroscience, Gilenya’s is Novartis, and Tecfidera and Tysabri’s is Biogen.
Patients taking Rituxan stayed on it significantly longer than other patients stuck with their drugs, researcher discovered. Among 120 patients treated with Rituxan, only seven quit during the four-year study period.
The main reason for discontinuation in four of the patients was pregnancy. One patient quit because their disease improved, and one because of side effects.
Researchers said patients on Tecfidera and Gilenya had the highest rates of discontinuing treatment due to their disease worsening or side effects. Thirty-eight percent stopped because their disease worsened and 28 percent because of side effects.
The main reason that Tysabri-treated patients quit was because tests showed they had John Cunningham virus. The virus is usually dormant. A compromised immune system can lead to it causing a life-threatening brain disease known as progressive multifocal leukoencephalopathy, or PML. A third of the patients on Tysabri tested positive for the virus.
Another finding was that increases in relapse rates and new brain lesions were more common in patients using treatments other than Rituxan.
In addition, patients taking injected therapies experienced mild side effects more often than those on Rituxan. Rates of moderate and severe adverse events were similar in the two groups.
“Collectively, our findings suggest that Rituximab performs better than other commonly used DMTs [disease-modifying drugs] in patients with newly diagnosed RRMS,” the researchers wrote.
While the study offered a glimpse of the effectiveness and safety of these drugs in a real-world setting, the team said more research of this kind is needed.