Effectiveness of Rituximab in rElapsiNg Multiple SclErosis previously treated with hiGhly-Active Disease modifying...

Area of Science:

• Neuroimmunology
• Clinical Neurology
• Pharmacology

Background:

• Highly effective disease-modifying therapies (HEDMTs) have transformed relapsing multiple sclerosis (RMS) treatment.
• Discontinuation of HEDMTs may lead to disease activity recurrence.
• Investigating Rituximab (RTX) as a subsequent therapy is crucial.

Purpose of the Study:

• To evaluate the effectiveness of Rituximab (RTX) in RMS patients.
• Focus on patients who discontinued prior HEDMTs due to efficacy or safety concerns.
• Assess RTX's impact on disability progression and disease activity.

Main Methods:

• Observational study of RMS patients switching to RTX from various HEDMTs (natalizumab, fingolimod, alemtuzumab, cladribine, cyclophosphamide, mitoxantrone).
• Comparison of disability progression (PIRA, PIRMA) and disease activity (ARR, RAW) at baseline, 12, and 24 months post-RTX initiation.
• Data collected from the Italian Multiple Sclerosis and Related Disorders Register.

Main Results:

• Of 68,621 RMS patients, 362 were analyzed after RTX treatment.
• Disability outcomes remained stable in natalizumab and cyclophosphamide-mitoxantrone groups.
• Significant reductions in relapse-associated worsening (RAW), progression independent from relapse activity (PIRA), and progression independent from MRI activity (PIRMA) were observed in fingolimod, alemtuzumab, and cladribine groups after 2 years.

Conclusions:

• Rituximab (RTX) shows potential as a rescue therapy for RMS patients discontinuing HEDMTs.
• RTX can help manage disease activity and disability progression in vulnerable patient populations.
• Factors like higher EDSS and older age at RTX initiation predict higher risks of PIRA and PIRMA.