PMID- 36657326
OWN - NLM
STAT- MEDLINE
DCOM- 20230314
LR  - 20230314
IS  - 2211-0356 (Electronic)
IS  - 2211-0348 (Linking)
VI  - 70
DP  - 2023 Feb
TI  - Efficacy and safety of repeated low-dose rituximab therapy in relapsing-remitting 
      multiple sclerosis: A retrospective case series study.
PG  - 104518
LID - S2211-0348(23)00022-6 [pii]
LID - 10.1016/j.msard.2023.104518 [doi]
AB  - BACKGROUND: Rituximab (RTX) is an extensively used off-label drug for multiple 
      sclerosis (MS), whereas the induction and maintenance regimens vary widely among 
      studies. Few data are available on efficacy and safety of repeated low-dose RTX 
      therapy in MS patients. OBJECTIVE: This study aimed to evaluate the efficacy and 
      safety of repeated low-dose RTX therapy for relapsing-remitting MS (RRMS), the 
      most common form of MS affecting approximately 85% of patients. METHODS: Nine 
      RRMS patients were enrolled and the medical records were retrospectively 
      reviewed. RTX at 100 mg per week for three consecutive weeks was used as 
      induction therapy. Maintenance therapy was reinfusions of RTX at 100 mg every 6 
      months during the first year, followed by 100 mg every 6 to 12 months. Main 
      outcome measures included annualized relapse rate (ARR), expanded disability 
      status scale (EDSS) score, and T2 lesion burden on MRI for evaluating the 
      efficacy of low-dose RTX regimen. Meanwhile, adverse events (AEs) were recorded 
      to assess the safety of repeated RTX infusions. RESULTS: All patients were 
      females with an average onset age of 25.4 +/- 6.7 years. The median disease 
      duration before the first RTX infusion was 56 (range, 3-108) months and the 
      median follow-up period was 30 (range, 15-40) months. No relapses were recorded 
      in all patients after RTX therapy. Repeated low-dose RTX therapy resulted in a 
      dramatic reduction of median ARR (pre-RTX vs post-RTX, 1.1 vs 0, p = 0.012), 
      median EDSS score (2.0 vs 0, p = 0.007), and the number of T2 lesions on MRI 
      (35.6 +/- 18.0 vs 29.4 +/- 18.1, p = 0.001). A total of 35 episodes of AEs occurred 
      during repeated low-dose RTX therapy, and all of them were mild and transient. 
      CONCLUSION: Repeated low-dose RTX therapy is cost-effective for RRMS patients and 
      shows a good safety profile. It may be a promising option for those having no 
      access or poor response to first-line disease-modified drugs (DMDs), particularly 
      in low- or middle-income countries.
CI  - Copyright (c) 2023 The Author(s). Published by Elsevier B.V. All rights reserved.
FAU - Zhao, Daidi
AU  - Zhao D
AD  - Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 
      710038, China.
FAU - Zhao, Cong
AU  - Zhao C
AD  - Department of Neurology, Air Force Medical Center of PLA, Beijing 100142, China.
FAU - Lu, Jiarui
AU  - Lu J
AD  - Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 
      710038, China.
FAU - Han, Yu
AU  - Han Y
AD  - Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an 
      710038, China.
FAU - Sun, Tangna
AU  - Sun T
AD  - Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 
      710038, China.
FAU - Ren, Kaixi
AU  - Ren K
AD  - Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 
      710038, China.
FAU - Ma, Chao
AU  - Ma C
AD  - Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an 
      710038, China.
FAU - Zhang, Chao
AU  - Zhang C
AD  - Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 
      710038, China.
FAU - Li, Hongzeng
AU  - Li H
AD  - Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 
      710038, China. Electronic address: llihongzeng@163.com.
FAU - Guo, Jun
AU  - Guo J
AD  - Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 
      710038, China. Electronic address: guojun_81@163.com.
LA  - eng
PT  - Journal Article
DEP - 20230114
PL  - Netherlands
TA  - Mult Scler Relat Disord
JT  - Multiple sclerosis and related disorders
JID - 101580247
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 0 (Immunologic Factors)
SB  - IM
MH  - Female
MH  - Humans
MH  - Adolescent
MH  - Young Adult
MH  - Adult
MH  - Male
MH  - *Multiple Sclerosis, Relapsing-Remitting/drug therapy
MH  - Rituximab/therapeutic use
MH  - *Multiple Sclerosis/drug therapy
MH  - Retrospective Studies
MH  - Immunologic Factors/therapeutic use
MH  - Off-Label Use
OTO - NOTNLM
OT  - Efficacy
OT  - Multiple sclerosis
OT  - Relapsing-remitting MS
OT  - Rituximab
OT  - Safety
COIS- Declaration of Competing Interest The authors declare that there is no conflict 
      of interest.
EDAT- 2023/01/20 06:00
MHDA- 2023/03/15 06:00
CRDT- 2023/01/19 18:15
PHST- 2022/10/19 00:00 [received]
PHST- 2023/01/09 00:00 [revised]
PHST- 2023/01/13 00:00 [accepted]
PHST- 2023/01/20 06:00 [pubmed]
PHST- 2023/03/15 06:00 [medline]
PHST- 2023/01/19 18:15 [entrez]
AID - S2211-0348(23)00022-6 [pii]
AID - 10.1016/j.msard.2023.104518 [doi]
PST - ppublish
SO  - Mult Scler Relat Disord. 2023 Feb;70:104518. doi: 10.1016/j.msard.2023.104518. 
      Epub 2023 Jan 14.