Editor’s note: This is the third story in a three-part report examining the question, “Is rituximab a reasonable alternative treatment for MS?”, which was a topic discussed at this year’s Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). Here, we take an in-depth look at the arguments presented against rituximab as a therapeutic option.
Mitchell Wallin, MD, MPH, a neurologist and professor at George Washington University and the University of Maryland, says no, explaining in his presentation at ECTRIMS why he believes rituximab is not a reasonable alternative for the treatment of MS.
Wallin, who is also the director of the Veterans Affairs’ MS Center of Excellence-East, wrote an article last year titled “Rituximab is an acceptable alternative to ocrelizumab for treating multiple sclerosis – No.”
“My views are probably not as extreme as my title would suggest,” he said. “I’m gonna highlight four areas in why I think ocrelizumab [Ocrevus] is a better choice as a B-cell therapy for MS — mechanism of action, efficacy, safety, and cost.”
Mechanism of action
Rituximab was “the first CD20 antibody that was produced for patient care,” Wallin said. It is a mouse chimeric monoclonal antibody, composed of both mouse and human parts, while Ocrevus and ofatumumab (under investigation for MS), are second-generation anti-CD20 antibodies that are mostly or fully made of human protein.
The fact that Ocrevus has fewer non-human parts may reduce the chance that patients develop antibodies against the medicine, known as anti-drug antibodies, which decrease a treatment’s effectiveness over time.
Wallin also pointed out that while rituximab and Ocrevus bind overlapping regions of the CD20 protein in immune B-cells, the target regions are “similar but not the same.” Different antibodies adopt different shapes, which can change how efficiently they can eliminate B-cells.
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