Rituximab in secondary progressive multiple sclerosis: a meta-analysis.

Area of Science:

• Neurology
• Immunology

Background:

• Secondary progressive multiple sclerosis (SPMS) is characterized by accumulating disability and frequent relapses.
• Rituximab (RTX), a B-cell depleting therapy, has shown efficacy in relapsing forms of multiple sclerosis, but its role in SPMS requires further evaluation.

Purpose of the Study:

• To systematically review and evaluate the efficacy of rituximab (RTX) in stabilizing disability progression in patients with secondary progressive multiple sclerosis (SPMS).

Main Methods:

• A systematic review of MEDLINE and EMBASE databases was performed for studies published up to April 2023.
• Included studies involved at least 3 SPMS patients receiving intravenous RTX with a minimum 6-month follow-up.
• Primary outcomes included changes in Expanded Disability Status Scale (EDSS) scores and annualized relapse rate (ARR), analyzed using random-effects models and meta-regression.

Main Results:

• Thirteen studies with 604 SPMS patients were analyzed. No significant change in mean EDSS scores was observed after a mean 2-year follow-up (ΔEDSS = -0.21, p=0.16).
• Meta-regression indicated that pre-RTX EDSS scores, disease duration at RTX initiation, and time to outcome reporting were significantly associated with EDSS changes.
• A significant reduction in ARR was observed (ΔARR = 0.74, p=0.008), with data available for 245 patients.

Conclusions:

• Rituximab (RTX) demonstrates significant efficacy in reducing relapse frequency in SPMS patients.
• RTX may have potential in stabilizing disability progression over a 2-year period, especially in patients with shorter disease duration.
• Further research is warranted to fully elucidate the long-term effects of RTX on disability progression in SPMS.