Long-term Rituxan Treatment Is Effective and Safe in MS, Study Shows

Long-term Rituxan Treatment Is Effective and Safe in MS, Study Shows

The approved lymphoma therapy Rituxan (rituximab) has shown promise as a treatment for  multiple sclerosis.

A new study indicates the Genentech treatment is effective and safe against neurological diseases like MS for up to seven years.

The research, “Long-term safety of rituximab induced peripheral B-cell depletion in autoimmune neurological diseases,” was published in the journal PLOS One.

Rituxan targets a protein called CD20 in immune B-cells, which are responsible for the production of antibodies. The U.S. Food and Drug Administration (FDA) approved Rituxan as a treatment for lymphoma and rheumatoid arthritis.

The antibody in Rituxan leads to a depletion of certain B-cells. It is currently being investigated as a potential therapy for relapsing–remitting multiple sclerosis.

In fact, “rituximab is often used as an off-label therapy in patients with immune-mediated neurological disorders (PIMND), including multiple sclerosis,” the researchers wrote.

Off-label use means Rituxan is prescribed as a therapy for diseases other than those for which it was approved.

While open-label and randomized controlled studies have shown promising results for Rituxan in disorders other than lymphoma or rheumatoid arthritis, scientists have had long-term safety concerns about it. Those concerns are particularly important because Rituxan can be prescribed for years.

A team of researchers decided to examine the “long-term safety, incidence of infections, and malignancies in subjects receiving continuous therapy with the B-cell-depleting agent rituximab over at least three years or longer.”

They looked at the records of multiple sclerosis who had received Rituxan a minimum of 18 months. The analysis included patients with neuromyelitis optica and myasthenia gravis treated with Rituxan for the same period.

The primary endpoint of the study was to assess rituxan’s long-term safety —  in terms of adverse and serious adverse events — in patients treated between three and seven years without interruption.

Patients received Rituxan intravenously in 1,000 mg doses administered twice a year or every six to nine months. The number of B-cells in their blood was determined at baseline and before each treatment cycle, and a medical evaluation was performed every three months.

The analysis included 29 patients — 22 women and seven men. Five patients had multiple sclerosis, three myasthenia gravis, and 21 neuromyelitis optica.

“We observed complete depletion of circulating B-cells in the majority of the patients and marked depletion in some of the patients throughout the treatment period,” the researchers wrote.

Rituxan was well tolerated, and the rate of adverse and serious adverse events was low. Also, “there were no cases of progressive multifocal leukoencephalopathy (PML) or malignancies observed throughout the observation period,” the team wrote.

PML is a rare brain infection that has been associated with long-term use of some therapies.

“This study demonstrates that long-term depletion of peripheral B-cells appears safe and efficacious in treating PIMND. Longer and larger prospective studies with rituximab are needed to carefully ascertain risks associated with chronic B-cell depletion, including malignancies,” researchers wrote.

They emphasized that although this was a small study, the results “complement the growing literature [scientific studies] documenting the safety and tolerability of B-cell-depleting agents in neurological diseases.”

Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.
Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.
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  1. Clive Arup says:

    I’ve been treated with Rituximab for the last seven years for RA but also have had PPMS since diagnosis in 1997. It’s been great for RA and who knows re the MS – might have done some good. Anyway well tolerated and reduced dosage to single infusion approx once per year now.

    • Richard says:

      Clive, how’s the progression of PPMS after taking Rituximab?? I have been diagnosed with PPMS recently and took 2 g of Rituximab over 2 weeks course as 2 infusions 2 months before. Could you please shed some light on it. I am a bit tensed about the progression of disease.

  2. Steven Johnson says:

    I have secondary progressive MS. I was just started on rituxin last summer. This article encourages me a great deal. I’ve had no adverse effects & I’m due for my next round of infusions in the very near future. Have any studies included secondary progressive patients?

  3. Scotty says:

    I also have secondary progressive MS and have been on Rituxan for over 3 years with no adverse effects. My neurologist, my wife, and I all believe that it is working/helping. During the past 3 years while on Rituxan, I have had the least amount of progression/symptoms that I have experienced in any other 3 year period of my 30 years with the disease.

    I also retired from my teaching job which may also have helped?

  4. Ally Grant says:

    I was prescribed 5X 500mg doses over the course of a year of Rituximab as a follow-up medication after my HSCT treatment for my RRMS to kill off any ‘rogue’ MS cells that may have remained after the chemotherapy had done its work and it certainly appears to have done that.

  5. Jose Johnson says:

    I have been taking Rituximab for primary progressive MS over 18 months. I get an IV every six months. I now plan to get a stem cell treatment. I do not want the Rituximab to interfere with the new injected stem cells. Question: How long does Rituximab stay in the system?

  6. Karen says:

    Has anyone experienced hair thinning or loss? I have RRMS and have just begun rituxan treatment and am very concerned about this particular side affect.

  7. Gary Jarvis says:

    Does the Rituxan have a limit on how much you can take like Methotrexate does. Do tests have to be done before each dose of Rituxan is given such as ejection fraction of the heart. Thank you.

  8. T. Young says:

    The Rituxan seems to be helping although I often experience a burning sensation in my abdominal area. Because Rituxan is off labeled for the MS disease, my copayment is extremely high. Is there a resource that provides assistance to help pay for the treatment?
    ( We are still paying off the first infusion).

    • Lauren says:

      Yes! The company has a copay assistance program. There should be info on their website. Or Google rituxan copay assistance. Good luck!

    • Anthony Reed says:

      I would suggest trying to contact your local Vocational Rehabilitation agency, they are a state agency that helps those whom are disabled in various ways

  9. Ishrat says:

    I get 4 doses of Rituximab 500mg once in a week for 4 weeks in a month.. Then stop for 6 month and then my doctor increased the dose to 600mg… I dont know why. And how long i have to take this!

  10. I was diagnosed with Tumefactive Multiple Sclerosis (just a rare form of RRMS where one or more lesion resemble brain tumors) back in March of 2012. Started treatment immediately on Avonex the side effects of that were worse then my MS symptoms after about a year of absolute misery I switched to Tecfidera which has seemed to work well since then however I just last month had a fairly sever exasterbation that lasted two weeks and hospitalized me for 5 days. It took Two doses of steroids to get back to my baseline but at least I recovered.. MRI showed one new active lesion on my spine so now my Nuroligist wants me to switch to Rituxan so I’ve been dong a lot of research and so far it all sounds promising. The only thing I’ve come across is one study where extended use of Rituxan can increase your risk for secondary infections such as pneumonia, which, at least for me, means a relapse and certain hospitalization. So my question is has anyone experienced any secondary infections due to suppressed immune system from long term use of Rituxan?

    • Lori Carp says:

      I’ve been on Rituxan for almost 3 years for RRMS. I too have tumafactive lesions on my brain. It was the first medication I was placed on and I thankfully have not had any new lesions since. I really haven’t had any terrible side effects. I believe this drug is life changing and I highly recommend it!

    • Dawn says:

      I’ve been on rituxan for going on 2-years for RRMS and RA .. my doctor made sure I got the pneumonia shot and the booster this year thus far I’m good knock on wood! And my immune count is pretty low on my recent labs.. I’m also around a lot of people for work and have managed ok…

    • N Pradhan says:

      I have been diagnosed with RRMS in 2015 and I started with Tecfidera which I took for almost 1.5years. However in a single year I got multiple relapses. Then my doctor suggested Rituximab. Have been taking it since last year. Have already taken 3gm of it. My next dose is in December. After taking Rituximab, I have not got any relapses. It feels like I never had MS!! For me it has really worked.

    • Lani Gantz says:

      I have been taking Rituxan infusion 4 times a year for over 10 years for Rheumatoid arthritis & it has helped with my MS symptoms so much that I have not had any new lesions for 9 years. I have not had any infections or pneumonia. I swear by Rituxan, it’s changed my life.

      • Dawntastic says:

        Very inspired! I have RRMS and RA as well going on 2-years Rituxan treatment.. for the first time since diagnosed 5-years ago . I had no new lesions on my recent MRI! Cross fingers I have your same luck!

  11. Jose Johnson says:

    All MS medicine suppresses immune system. To boost it do one of the following once a day if possible: 1) eat a can of beets ($1 per can) 2) juice carrots (3/4 glass) 3) eat raw carrots 4) eat kale 5) eat collard greens. Just do one of these 4 choices daily. NOTE: Dr. John McDougall pure vegan diet stops the progression of MS. The pain and relapse decrease by >80%. He learned from Dr. Roy Swank (father of MS). Daily fat I think less than 40 calories per day. I now follow this instead of retuximab

  12. Jose Johnson says:

    I last took rituximab February 2018. I have been using the Dr. John McDougall pure vegan low fat diet past 18 month and am doing much better. I plan a stem cell IV in March. Someone wrote that rituximab for MS (taken once every 6 months) takes 1 year to totally be removed from ones body. I need it totally removed from my body so it doesn’t manipulate my cells. Question: Is it correct that the rituximab is totally gone from my body in 12 months?

  13. Candan says:

    I have RMMS and I was supposed to get my second Rituximab infusion next week but unfortunately my insurance is terminated. My question is how will it effect the course of treatment if I have my second infusion in 7 months rather than 6? Thank you 🙂

    • Ana says:

      i too just started rItuximab, based on what my neurologist told me it shouldnt have an affect on your treatment. She shared that rituximab is time friendly and you can take at the 6, 7 month period.

  14. Mary K Taylor says:

    I was diagnosed 2 years ago with RRMS had symptoms for years. I am currently on Copaxone and take 3 shots a week. I have been fortunate enough since starting treatment to not have a lot of side effects. My question is, what would be the benefits for switching to this infusion and dose going to an infusion this early in the disease will it limit further medications from being effective?

    • Miko says:

      I was diagnosed with the same thing, I was also on copaxone. It left too many painful welts in which my doctor switched me to Rituxan & so far it is a life changer. Good luck 🍀.

    • Dawntastic says:

      This is how my Nuerologist explained it to me. I’m on my 3-rd type of treatment now. Adagio was a pill unfortunately it made me have a kidney infection. Next Glatopia injections that I did well on and felt pretty good . However he said those injections are like allergy medicine they help the symptoms BUT don’t slow down the disease! Now I’m on Rituxan infusions and it actually could potentially do just that? So I said let’s Do It! Because with all my other medications I continued to have very active brain lesions… after my first Rituxan treatment was the first time in 5-years I had a MRI with NO new leasions.. hope that helps

  15. Frank Azari says:

    I have a secondary MS and am taking Mavenclad and am thinking to do stem cell treatment, anybody knows a good place to do it.
    thank you

  16. Cristina says:

    I started on Rituxan 1 month ago had 2 infusions. Was On Tysabri treatment for 5 minths prior which made my symptoms in my head really bad. Doc and MS NURSE couldn’t tell me to stop it if i was so bad just kept tellibg me to try one more n one more dose.. i started to feel better when stopped it and Feel good after Rituxan!hope it will make me feel better and better every day! I recommend Rituxan
    I have RRMS

    • Kk says:

      I am on my second round of Rituxan. Everything seems ok except frequently urination way too much. Excuse me for that . I had a UTI but still I could fill a pond lol. Anyone else having crazy trips to pee!!! I’m very concerned. This medication by far is the better ones 23 years with MS tried just about most MS meds they don’t work or I’m allergic. But Tysabri was excellent I felt good too after 5 months.

      • Kk says:

        Oh too early to tell if Rituxan is helping Dr. says it could e 18 months before I feel any improvement as I have had many flare ups over the course of 5 years and was in a flare up for 4months so I’m just now starting to go back to baseline. Lots of damage 😔

  17. Garrett says:

    I’ve been on rituximab for almost 3 years now with Kaiser since my initial diagnosis of MS.
    1 dose was 1000mg, subsequent doses are 6 months apart and at 500mg. After the fifth dosage I will continue based on blood work.
    I feel great 95% of the time with 5% being minor relapses of the same initial symptoms. No new lesions. Only infection was H. Pylori that I’m just now getting over. No other infections that are advertised on the warning label.

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