Impact of rituximab in Mexican patients with Multiple Sclerosis–A single-center retrospective study

• Published in: Multiple sclerosis and related disorders 2022-02, Vol.58, p.103485-103485, Article 103485
• Main Authors: Bribiesca-Contreras, Elisa, García-Estrada, Christian, Gómez-Figueroa, Enrique, Zertuche-Ortuño, Lizeth, Rodríguez-Rivas, Roberto, Marcín-Sierra, Mariana, Delgado-Niño, Maryori, Rivas-Alonso, Verónica, Corona-Vázquez, Teresita, Flores-Rivera, José
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents - therapeutic use; ARR: anual relapsed rate; EDSS: expanded dissability status scale; Humans; Immunologic Factors - adverse effects; Multiple Sclerosis - chemically induced; Multiple Sclerosis - diagnostic imaging; Multiple Sclerosis - drug therapy; Multiple Sclerosis, Relapsing-Remitting - drug therapy; PI: progression index; PPMS: primary progressive Multiple Sclerosis; Retrospective Studies; Rituximab - adverse effects; RMS: relpasing Multiple Sclerosis
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2021.103485

•Treatment for people with Multiple Sclerosis (MS) is often expensive and difficult to access in lower and middle countries.•Rituximab is commonly used worldwide given its lower costs and availability.•Previous phase-I and phase-II clinical trials have reported reduction in relapses and MRI activity after rituximab treatment.•Rituximab treated patients were found to have lower annual relapse rates and less radiological activity compared to non-treated patients. Multiple Sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS). B cells have an essential role in the disease pathogenesis and therefore selective B-cell depletion are commonly used to treat the disease. Rituximab (RTX), a chimeric anti-CD20 monoclonal antibody had demonstrated reduced inflammatory activity and radiological activity in MS patients. Due to economic constrains and treatment access limitations, RTX is often used as a treatment alternative in these patients. Here, we described our center experience in RTX -treated MS patients. A single-center observational retrospective study was conducted in a Mexican cohort MS during 2010 to 2020. All patients had a confirmed MS diagnosis.All patients received fixed scheme involving induction with 1 g on day one and day 15, followed by 500 mg-1 g every six months for maintenance. Annual Relapse Rate (ARR), Progression index (PI), Expanded Disability Status Scale (EDSS) and MRI activity of the disease were evaluated. Comparison between naïve and non-naïve patients was also conducted. A total of 85 patients were included. The mean age at diagnosis was 33.13 (±8.90) years with 73 (85.9%) being RRMS. 39 (34.1%) were treatment-naïve. While treated with RTX, 62(72.9%) patients reached a free-of-relapse status, with statistically significant decrease in the mean ARR from 0.82 to 0.36 [0.14 (95%CI: 0.09–0.20), p = 0.0001 and EDSS [0.25 CI 0–0.5 (p = 0.034)] and a decrease in their T1 Gd-enhancing MRI lesions (1.64 vs. 0.12 CI 0.70–2.30, p = 0.004. 29 (29.4%) patients achieved NEDA-3. Among all patients, only 2 (2.4%) experienced infusion-related mild adverse events. No serious adverse events were reported. We found significant clinical and radiological improvement in naïve and non-naïve MS patients treated with RTX.