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Can the cancer drug rituximab treat multiple sclerosis (MS)?

Two infusions of the cancer drug Rituxan (rituximab), given two weeks apart, slowed the progression of multiple sclerosis (MS) for nearly one year, researchers reported. They also stated that the drug appears to be twice as effective as existing first-line treatments for MS. Findings were published in the New England Journal of Medicine.

"It's quite remarkable that the effect was sustained for 48 weeks with just a single course of therapy," said Dr. Stephen Hauser of the University of California at San Francisco, who worked on the study. (The two doses at weeks one and three are considered a loading dose.)

To assess the progress of the Rituxan participants, researchers used magnetic resonance imaging (MRI) scans to assess nervous system damage. They were surprised by the rapid effect on MS inflammatory measures and that the number of lesions dropped immediately after the two treatments.

Within 12 weeks, the number of lesions was statistically lower in the Rituxan group, while the number of lesions in the placebo group tended to stay the same or increase in number.
But the drug was not as good at preventing relapses. After 48 weeks, 20 percent of the 69 Rituxan recipients had suffered a relapse. In the placebo group, a relapse rate of 40 percent was noted in the 35 patients.

No head-to-head comparison study has been done thus far and this study did not assess long-term safety or adverse events. Moreover, the number and/or volume of T2 or enhancing
lesions do not necessarily correlate with the drug's efficacy.

Nevertheless, this research has provided further insight into B cell involvement in the inflammatory attacks in MS.

"Rituxan offers the potential for an effective and relatively convenient new therapy for MS," comments Multiple Sclerosis Foundation Publication (MSF) Medical Advisor Ben Thrower, M.D. "Phase III trials are continuing in relapsing and progressive forms of MS. There are also early trials in Devic's disease (neuromyelitis optica). Our experience with Rituxan has been through the primary-progressive MS (PPMS) trial and off-label use in Devic's disease. In the PPMS trial we are blinded, so we don't know if our patients are getting placebo or Rituxan. In our off-label use, we are giving 1000mg IV weeks one and three, then 1000mg IV every six months."

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