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Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
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Rituximab for people with multiple sclerosis.

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Rituximab effectively prevents relapses in multiple sclerosis (MS) when used as a first-choice or switching treatment compared to other disease-modifying therapies (DMTs). However, its impact on disability worsening and long-term safety in MS remains uncertain.

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Area of Science:

  • Neurology
  • Immunology
  • Pharmacology

Background:

  • Multiple sclerosis (MS) is a leading cause of neurological disability in young adults.
  • Rituximab is frequently used off-label for MS treatment globally, even where on-label therapies exist.
  • This review is an updated assessment of rituximab's efficacy and safety in MS management.

Purpose of the Study:

  • To evaluate the benefits and harms of rituximab as both an initial and subsequent treatment for adults with any form of MS.
  • To synthesize evidence from randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs).

Main Methods:

  • Comprehensive literature search across multiple databases (CENTRAL, MEDLINE, Embase, CINAHL) and trial registers up to December 2023.
  • Inclusion of RCTs and controlled NRSIs comparing rituximab to placebo or other disease-modifying treatments (DMTs).
  • Assessment of risk of bias using RoB 1 and ROBINS-I, and certainty of evidence using GRADE.

Main Results:

  • Rituximab may reduce relapse recurrence in relapsing MS (low-certainty evidence) and likely delays relapses compared to certain DMTs (moderate-certainty evidence).
  • Evidence regarding disability worsening, serious adverse events (SAEs), cancer, and mortality is often uncertain or of very low certainty.
  • An increased risk of serious infections was observed with rituximab compared to other DMTs, though the absolute risk is low.

Conclusions:

  • Rituximab demonstrates favorable outcomes in preventing relapses for relapsing MS, whether used as a first-choice or switching therapy.
  • The evidence on rituximab's effect on disability worsening and its long-term safety profile in MS is limited and uncertain.
  • Further high-quality, prospectively registered NRSIs are recommended to clarify the benefits and harms of rituximab in MS.