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LONDON—As a first- or second-line agent for relapsing-remitting multiple sclerosis (MS), rituximab demonstrates superior drug survival (ie, the proportion of patients remaining on a
Rituximab Is Not Indicated for MS
Rituximab, a chimeric mouse–human anti-CD20 monoclonal antibody, is not approved as an MS treatment, but researchers have studied it for this indication. Naismith et al found that rituximab effectively treated breakthrough disease in patients with relapsing-remitting MS.
In a retrospective, observational study, Fredrik Piehl, MD, Professor of Neuroimmunology at Karolinska Institutet in Stockholm, and colleagues examined outcomes in patients with MS who switched from natalizumab to rituximab or fingolimod as part of a risk-management strategy. Compared with patients who switched to fingolimod, patients who switched to rituximab had lower risks of clinical relapses and adverse events. 
These results prompted Dr. Piehl and colleagues to conduct a study to compare the baseline characteristics and outcomes of patients with relapsing-remitting MS starting rituximab, fingolimod, or natalizumab. The investigators used data from the Swedish Neuroregistry, which contains information on approximately 80% of all Swedish patients with MS. They included 4,244 patients in their final analysis and examined only the first period for each therapy and patient.
Rituximab Reduced Likelihood of Relapse
Approximately 14% of Swedish patients with relapsing-remitting MS received natalizumab, 10% received fingolimod, and 29% received rituximab. Patients who initiated therapy with natalizumab tended to be younger, have a higher Expanded Disability Status Scale (EDSS) score, and have more active disease at baseline, compared with the other participants.
Drug survival was greater among all patients who ever received rituximab, compared with all patients who ever received fingolimod or natalizumab. When the researchers examined the drugs as first-line agents, drug survival was greater with rituximab than with the other therapies. They found the same result when they analyzed the treatments as second-line agents. Among patients who switched from natalizumab, drug survival was greater in patients who initiated rituximab, compared with those who initiated fingolimod.
Relapse-free survival was most likely among patients receiving rituximab, compared with patients receiving fingolimod or natalizumab. When the researchers analyzed the drugs as first-line agents, they found that relapse-free survival was more likely with rituximab than with the other therapies, but the difference was small. The difference in relapse-free survival was greater, however, when the researchers analyzed the three drugs as second-line therapies.
“The strengths of this study are that it is nationwide and [that] it is a real-world population, including patients with various comorbidities,” said Dr. Piehl. The study results were susceptible to hidden confounding by indication, however. Another weakness of the study was its retrospective, observational design, said Dr. Piehl.
—Erik Greb
Suggested Reading
Naismith RT, Piccio L, Lyons JA, et al. Rituximab add-on therapy for breakthrough relapsing multiple sclerosis: a 52-week phase II trial. Neurology. 2010;74(23):1860-1867.
Salzer J, Svenningsson R, Alping P, et al. Rituximab in multiple sclerosis: A retrospective observational study on safety and efficacy. Neurology. 2016 Oct 19 [Epub ahead of print].
LONDON—As a first- or second-line agent for relapsing-remitting multiple sclerosis (MS), rituximab demonstrates superior drug survival (ie, the proportion of patients remaining on a
Rituximab Is Not Indicated for MS
Rituximab, a chimeric mouse–human anti-CD20 monoclonal antibody, is not approved as an MS treatment, but researchers have studied it for this indication. Naismith et al found that rituximab effectively treated breakthrough disease in patients with relapsing-remitting MS.
In a retrospective, observational study, Fredrik Piehl, MD, Professor of Neuroimmunology at Karolinska Institutet in Stockholm, and colleagues examined outcomes in patients with MS who switched from natalizumab to rituximab or fingolimod as part of a risk-management strategy. Compared with patients who switched to fingolimod, patients who switched to rituximab had lower risks of clinical relapses and adverse events.
These results prompted Dr. Piehl and colleagues to conduct a study to compare the baseline characteristics and outcomes of patients with relapsing-remitting MS starting rituximab, fingolimod, or natalizumab. The investigators used data from the Swedish Neuroregistry, which contains information on approximately 80% of all Swedish patients with MS. They included 4,244 patients in their final analysis and examined only the first period for each therapy and patient.
Rituximab Reduced Likelihood of Relapse
Approximately 14% of Swedish patients with relapsing-remitting MS received natalizumab, 10% received fingolimod, and 29% received rituximab. Patients who initiated therapy with natalizumab tended to be younger, have a higher Expanded Disability Status Scale (EDSS) score, and have more active disease at baseline, compared with the other participants.
Drug survival was greater among all patients who ever received rituximab, compared with all patients who ever received fingolimod or natalizumab. When the researchers examined the drugs as first-line agents, drug survival was greater with rituximab than with the other therapies. They found the same result when they analyzed the treatments as second-line agents. Among patients who switched from natalizumab, drug survival was greater in patients who initiated rituximab, compared with those who initiated fingolimod.
Relapse-free survival was most likely among patients receiving rituximab, compared with patients receiving fingolimod or natalizumab. When the researchers analyzed the drugs as first-line agents, they found that relapse-free survival was more likely with rituximab than with the other therapies, but the difference was small. The difference in relapse-free survival was greater, however, when the researchers analyzed the three drugs as second-line therapies.
“The strengths of this study are that it is nationwide and [that] it is a real-world population, including patients with various comorbidities,” said Dr. Piehl. The study results were susceptible to hidden confounding by indication, however. Another weakness of the study was its retrospective, observational design, said Dr. Piehl.
—Erik Greb
Suggested Reading
Naismith RT, Piccio L, Lyons JA, et al. Rituximab add-on therapy for breakthrough relapsing multiple sclerosis: a 52-week phase II trial. Neurology. 2010;74(23):1860-1867.
Salzer J, Svenningsson R, Alping P, et al. Rituximab in multiple sclerosis: A retrospective observational study on safety and efficacy. Neurology. 2016 Oct 19 [Epub ahead of print].
LONDON—As a first- or second-line agent for relapsing-remitting multiple sclerosis (MS), rituximab demonstrates superior drug survival (ie, the proportion of patients remaining on a
Rituximab Is Not Indicated for MS
Rituximab, a chimeric mouse–human anti-CD20 monoclonal antibody, is not approved as an MS treatment, but researchers have studied it for this indication. Naismith et al found that rituximab effectively treated breakthrough disease in patients with relapsing-remitting MS.
In a retrospective, observational study, Fredrik Piehl, MD, Professor of Neuroimmunology at Karolinska Institutet in Stockholm, and colleagues examined outcomes in patients with MS who switched from natalizumab to rituximab or fingolimod as part of a risk-management strategy. Compared with patients who switched to fingolimod, patients who switched to rituximab had lower risks of clinical relapses and adverse events.
These results prompted Dr. Piehl and colleagues to conduct a study to compare the baseline characteristics and outcomes of patients with relapsing-remitting MS starting rituximab, fingolimod, or natalizumab. The investigators used data from the Swedish Neuroregistry, which contains information on approximately 80% of all Swedish patients with MS. They included 4,244 patients in their final analysis and examined only the first period for each therapy and patient.
Rituximab Reduced Likelihood of Relapse
Approximately 14% of Swedish patients with relapsing-remitting MS received natalizumab, 10% received fingolimod, and 29% received rituximab. Patients who initiated therapy with natalizumab tended to be younger, have a higher Expanded Disability Status Scale (EDSS) score, and have more active disease at baseline, compared with the other participants.
Drug survival was greater among all patients who ever received rituximab, compared with all patients who ever received fingolimod or natalizumab. When the researchers examined the drugs as first-line agents, drug survival was greater with rituximab than with the other therapies. They found the same result when they analyzed the treatments as second-line agents. Among patients who switched from natalizumab, drug survival was greater in patients who initiated rituximab, compared with those who initiated fingolimod.
Relapse-free survival was most likely among patients receiving rituximab, compared with patients receiving fingolimod or natalizumab. When the researchers analyzed the drugs as first-line agents, they found that relapse-free survival was more likely with rituximab than with the other therapies, but the difference was small. The difference in relapse-free survival was greater, however, when the researchers analyzed the three drugs as second-line therapies.
“The strengths of this study are that it is nationwide and [that] it is a real-world population, including patients with various comorbidities,” said Dr. Piehl. The study results were susceptible to hidden confounding by indication, however. Another weakness of the study was its retrospective, observational design, said Dr. Piehl.
—Erik Greb
Suggested Reading
Naismith RT, Piccio L, Lyons JA, et al. Rituximab add-on therapy for breakthrough relapsing multiple sclerosis: a 52-week phase II trial. Neurology. 2010;74(23):1860-1867.
Salzer J, Svenningsson R, Alping P, et al. Rituximab in multiple sclerosis: A retrospective observational study on safety and efficacy. Neurology. 2016 Oct 19 [Epub ahead of print].
