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Rituximab in multiple sclerosis

Artikel i vetenskaplig tidskrift
Författare J. Salzer
R. Svenningsson
P. Alping
Lenka Novakova
A. Björck
K. Fink
P. Islam-Jakobsson
Clas Malmeström
Markus Axelsson
M. Vågberg
P. Sundström
Jan Lycke
F. Piehl
A. Svenningsson
Publicerad i Neurology
Volym 87
Nummer/häfte 20
Sidor 2074-2081
ISSN 0028-3878
Publiceringsår 2016
Publicerad vid Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering
Sidor 2074-2081
Språk en
Länkar dx.doi.org/10.1212/WNL.000000000000...
Ämneskategorier Neurologi

Sammanfattning

Objective: To investigate the safety and efficacy of rituximab in multiple sclerosis (MS). Methods: In this retrospective uncontrolled observational multicenter study, off-label rituximab-treated patients with MS were identified through the Swedish MS register. Outcome data were collected from the MS register and medical charts. Adverse events (AEs) grades 2-5 according to the Common Terminology Criteria for Adverse Events were recorded. Results: A total of 822 rituximab-treated patients with MS were identified: 557 relapsing-remitting MS (RRMS), 198 secondary progressive MS (SPMS), and 67 primary progressive MS (PPMS). At baseline, 26.2% had contrast-enhancing lesions (CELs). Patients were treated with 500 or 1,000 mg rituximab IV every 6-12 months, during a mean 21.8 (SD 14.3) months. During treatment, the annualized relapse rates were 0.044 (RRMS), 0.038 (SPMS), and 0.015 (PPMS), and 4.6% of patients displayed CELs. Median Expanded Disability Status Scale remained unchanged in RRMS (p 0.42) and increased by 0.5 and 1.0 in SPMS and PPMS, respectively (p 0.10 and 0.25). Infusion-related AEs occurred during 7.8% of infusions and most were mild. A total of 89 AEs grades ≥2 (of which 76 infections) were recorded in 72 patients. No case of progressive multifocal leukoencephalopathy was detected. Conclusions: This is the largest cohort of patients with MS treated with rituximab reported so far. The safety, clinical, and MRI findings in this heterogeneous real-world cohort treated with different doses of rituximab were similar to those reported in previous randomized controlled trials on B-cell depletion therapy in MS. Classification of evidence: This study provides Class IV evidence that for patients with MS, rituximab is safe and effective. © 2016 American Academy of Neurology.

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