Text Size: a  |   a 

Rituximab is Flying Under the Radar

October 13, 2015

The hot topic of the latest ECTRIMS meeting was the great success of the drug Ocrelizumab. This injectable drug has proven to be effective in treating both progressive and relapsing forms of MS. However, there is an older drug that is already on the market that is actually showing similar results.

Rituximab is that drug, and a few presentations at the conference did happen to mention its success:

  • Among 36 patients with secondary progressive MS given rituximab at a university hospital in Switzerland, the risk of confirmed progression was cut by nearly 80% compared to conventionally treated patients.
  • At the University of Colorado in Denver, records for 313 patients treated with rituximab since 2007 (including RRMS, SPMS and PPMS) indicated that relapses were abolished in all but five patients, and only seven subsequently showed new T2 lesion activity.
  • Experience at three MS referral centers in Sweden, where more than 900 patients have received rituximab since 2008 (65% RRMS, 35% PP/SPMS), included annualized relapse rates of 0.04 in RRMS patients and 0.03 in PP/SPMS. Rates of lesions in the two groups were 0.05 and 0.02 per year, respectively.
  • Another Swedish review, covering 256 patients who switched from natalizumab (Tysabri) to rituximab or the oral drug fingolimod (Gilenya) because of JC virus positivity, found that rates of relapse and new MRI lesion activity were markedly lower in those taking rituximab. Moreover, about 30% of those switching to fingolimod stopped the drug within 2 years, versus less than 5% of those moving to rituximab.

However, the drug is manufactured by Roche (the same company as Ocrelizumab) so it is unlikely that it will be approved for marketing over the newer drug. This means that more randomized and controlled studies will probably not take place.
Rituximab treatment is taken intravenously and runs at about $30,000 per year for rheumatoid arthritis, an FDA-approved indication, with two 1,000-mg doses 14 days apart. The dosing schedules reported with off-label use for MS have been similar.