Editor’s note: This is the first 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 provide a synopsis of the argument.
More than two years after the approval of Ocrevus (ocrelizumab), B-cell therapies continue to be seen as promising approaches for multiple sclerosis (MS). But it has been debated if rituximab — a B-cell therapy used off-label in MS and also marketed by Genentech — could provide similar or even superior benefits compared with Ocrevus, and at a lower cost.
This question was the focus of a hot topic discussion at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held Sept. 11–13 in Stockholm, where a group of researchers and neurologists voiced their opinions about whether or not rituximab is a reasonable alternative to Ocrevus for people with relapsing MS.
Immune cells homing to the brain and spinal cord (the central nervous system, or CNS) to trigger local inflammation, demyelination (loss of myelin, the protective coat of neurons), and nerve cell death are central for MS. And B-cells, a type of white blood cells, have been identified as relevant players in this process.
For this reason, immunosuppressive treatments that target B-cells have emerged as important therapeutic strategies for MS.
Efforts have been focused on so-called anti-CD20 therapies — antibodies that pinpoint a specific protein on the surface of B-cells called CD20, targeting them for destruction and resulting in B-cell depletion.
Genentech’s Ocrevus is one of these therapies, and the only approved treatment for both relapsing and primary progressive MS (PPMS). It is an engineered (made in the lab) anti-CD20 antibody, given by intravenous (into-the-vein) infusion.
In clinical trials, Ocrevus demonstrated clear benefits. It reduced the rate of relapses and disease activity in patients with relapsing MS, compared with Rebif (interferon beta-1a), and lowered the risk of disability progression in people with PPMS, compared with placebo.
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