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Rituximab vs Ocrelizumab in Relapsing-Remitting Multiple Sclerosis.

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Rituximab is not as effective as ocrelizumab for treating relapsing-remitting multiple sclerosis (MS). This study found rituximab associated with a higher risk of relapses compared to ocrelizumab in real-world MS treatment.

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Area of Science:

  • Neuroimmunology
  • Pharmacology

Background:

  • Ocrelizumab effectively reduces relapses and disability worsening in relapsing-remitting multiple sclerosis (MS).
  • Rituximab, an anti-CD20 agent, is frequently used off-label as an alternative to ocrelizumab for MS management.

Purpose of the Study:

  • To determine if rituximab is noninferior to ocrelizumab in treating relapsing-remitting MS.
  • To compare the effectiveness of rituximab versus ocrelizumab in a real-world setting.

Main Methods:

  • An observational cohort study utilizing data from the MSBase and Danish MS Registries (DMSR) between January 2015 and March 2021.
  • Propensity score matching was used to compare patients treated with ocrelizumab or rituximab, controlling for baseline characteristics.
  • Annualized relapse rates (ARRs) were the primary outcome, with a noninferiority margin of 1.63 rate ratio.

Main Results:

  • The study included 1613 patients with relapsing-remitting MS (710 on ocrelizumab, 186 on rituximab) after propensity score matching.
  • Rituximab treatment was associated with a significantly higher annualized relapse rate compared to ocrelizumab (rate ratio, 1.8; P < .001).
  • No significant difference was observed in the risk of 6-month confirmed disability accumulation between the two treatment groups.

Conclusions:

  • Rituximab did not demonstrate noninferiority to ocrelizumab in this comparative effectiveness study.
  • In clinical practice, rituximab appears to be associated with a higher risk of relapses than ocrelizumab for MS treatment.
  • Further evaluation in randomized trials is warranted to confirm the efficacy of rituximab and ocrelizumab at standardized doses and intervals.