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Thread: Safety/Efficacy of Rituximab

  1. #1
    Distinguished Community Member SuzE-Q's Avatar
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    Default Safety/Efficacy of Rituximab

    Review of records from a single clinic:


    Clin Neuropharmacol. 2018 Jan 31. doi: 10.1097/WNF.0000000000000268. [Epub ahead of print]

    Safety and Efficacy of Rituximab: Experience of a Single Multiple Sclerosis Center.

    Alldredge B1, Jordan A, Imitola J, Racke MK.

    OBJECTIVES:
    Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. B cells play an important pathogenic role in MS. Rituximab (RTX), a B-cell depleting drug, has been used to treat MS and neuromyelitis optica (NMO). Patient characteristics, safety, and efficacy measures are reviewed to ascertain the therapeutic benefit and safety of RTX in a real-world setting with long-term follow-up.

    METHODS:
    This is a retrospective chart review of patients who received RTX at The Ohio State University's MS clinic from January 2005 to October 2016.

    RESULTS:
    Of the 64 patient charts reviewed, 23 had a relapsing remitting MS, 17 had primary progressive MS (PPMS), and 24 had NMO. In the relapsing remitting MS cohort, there was an annual relapse rate of 0.005 and 87% were reported as clinically stable at the end of the chart review period.

    In the primary progressive MS cohort, 47% were reported as clinically stable at the end of the chart review period. In the NMO cohort, there was an annual relapse rate of 0.0074 and 79% were reported as clinically stable at the end of the chart review period. A total of 29 infusion reactions were reported in 21 patients. None were serious and only 1 patient elected to stop RTX due to an adverse event.

    CONCLUSIONS:
    Rituximab demonstrated good tolerability and efficacy in cases of both relapsing and progressive forms of MS and NMO.

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  3. #2
    Distinguished Community Member Sunshine's Avatar
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    Good article. Thanks for it and good to see you Suzy

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  5. #3
    Distinguished Community Member SuzE-Q's Avatar
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    I hadn't realized ANY cases of PML had been associated with rituximab?

    Is its safety profile better than Ocrevus, I wonder?

    https://www.ncbi.nlm.nih.gov/pubmed/29985084


    Mult Scler. 2018 Jul 1:1352458518786075. doi: 10.1177/1352458518786075. [Epub ahead of print]

    Drug-associated progressive multifocal leukoencephalopathy in multiple sclerosis patients.

    Oshima Y1, Tanimoto T2, Yuji K1, Tojo A1.

    Abstract
    OBJECTIVE:
    To investigate characteristics of multifocal leukoencephalopathy (PML) in multiple sclerosis (MS) patients associated with drugs other than natalizumab since our experience in other disease-modifying drugs (DMD) is still limited.

    METHODS:
    This is a descriptive observational study within the FAERS database, registered between July 2015 and June 2017.

    RESULTS:
    The primary cohort for the analysis consisted of 100,921 MS patients (mean (standard deviation (sd)) age, 48.9 (12.8) years, 20.9% male). Among them 786 (0.78%) developed PML. The adjusted odds ratio of PML for each drug was as follows; natalizumab 115.72 (95% CI; 83.83, 159.74), fingolimod 4.98 (3.64, 6.81) followed by dimethyl fumarate 1.77 (1.2, 2.62) and rituximab 3.22 (1.07, 9.72).

    The median time from the start of suspected drugs to the onset of PML for natalizumab and other agents were 1463 and 178 days, respectively. The proportion of PML appeared higher in Japan (2.4%) compared to that in the United States (0.24%).

    CONCLUSION:
    The relative risk of PML with natalizumab was much higher than with any of the other DMDs and one with fingolimod followed. One with dimethyl fumarate and rituximab was lesser. Glatiramer acetate, interferon, and dalfampridine were not associated with PML risk based on our analysis.
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    Hi Suze, I had not realized any cases had been tied to rituximab either. I was going to ask my Neuro about me taking it next week.

    Thanks for article. Nice to see you.
    Virginia

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    Distinguished Community Member agate's Avatar
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    I don't think that there have been any PML cases resulting from using rituximab in MS patients but there were some cases in patients with RA on rituximab.

    The 4 PML cases in MS patients on Ocrevus probably occurred because there hadn't been a long enough washout period after stopping Tysabri for those patients--?
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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    Distinguished Community Member SuzE-Q's Avatar
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    Agate, yes, they all had earlier, recent Tysabri exposure, so that might have been the cause of it for Ocrevus patients. Yes, I'd forgotten the RA patients, will ask my doctor their info regarding dosage, etc.

    Hi Virginia, I'm talking to my doctor about it end of month too. Let me know what you learn, and what your doctor thinks, ok? I think I might ask for a JC titer to see what I'm starting out with. That might help me to decide, even though I've not yet been on any PML-causing meds.
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    Susie, I am sure they would do a JC titer on me. I have been on an interferon for nearly 20 years. Even though no PML is associated with the interferons, I am sure they have an effect of the immune system.

    I am only doing this because I can no longer get the interferon at an affordable price. I was being helped though Patient Assistance Network. However, that stopped the first of July for me. I am going to take the money out of savings and pay for it the rest of the year, but there is no way I can do it next year also. Unless my Neuro has some input and something he can do I have no alternatives left for me. My income is too much for all other people who help with drugs, but not enough to pay for the one I am getting. I am falling through the cracks.

    I will let you know what my Neuro has to say re Rituxan, and you do the same. I see mine the end of next week.
    Last edited by Virginia; 07-10-2018 at 08:48 AM.
    Virginia

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    Distinguished Community Member Lazarus's Avatar
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    Quote Originally Posted by SuzE-Q View Post
    This quote is hidden because you are ignoring this member. Show Quote
    I hadn't realized ANY cases of PML had been associated with rituximab?

    Is its safety profile better than Ocrevus, I wonder?

    https://www.ncbi.nlm.nih.gov/pubmed/29985084


    Mult Scler. 2018 Jul 1:1352458518786075. doi: 10.1177/1352458518786075. [Epub ahead of print]

    Drug-associated progressive multifocal leukoencephalopathy in multiple sclerosis patients.

    Oshima Y1, Tanimoto T2, Yuji K1, Tojo A1.

    Rituximab is about the safest med we can take. And there are no side effects. And it is useful with progressive forms of ms.
    I take it even though I am jcv positive.
    Linda~~~~

    Be the kind of woman that when your feet hit the floor each morning the devil says:"Oh Crap, She's up!"

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    There have been no cases of PML in MS patients on Rituxan.

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  19. #10
    Distinguished Community Member SuzE-Q's Avatar
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    Cherie, do you know how many MS patients have been on rituximab?

    Virginia, I'm sorry it's a financial and not medical decision that is prompting the potential change in meds. Thanks for any added info you are able to share from your doc!

    Lazarus, thanks, as always for your personal insight!
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