A Real-World Experience of Rituximab: A Panacea in Therapy of Multiple Sclerosis in Low- and Middle-Income Setting

Pritam Raja; Kamakshi Dhamija; M M Samim; Jitender Saini; Mandara Ganganakudige Manjappaiah; Thennarasu Kandavel; Netravathi M

doi:10.1097/WNF.0000000000000612

A Real-World Experience of Rituximab: A Panacea in Therapy of Multiple Sclerosis in Low- and Middle-Income Setting

Clin Neuropharmacol. 2024 Sep 12. doi: 10.1097/WNF.0000000000000612. Online ahead of print.

Authors

Pritam Raja¹, Kamakshi Dhamija¹, M M Samim¹, Jitender Saini², Mandara Ganganakudige Manjappaiah¹, Thennarasu Kandavel³, Netravathi M¹

Affiliations

¹ Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India.
² Department of Neuroimaging & Interventional Neuroradiology (NIIR), National Institute of Mental Health & Neurosciences, Bangalore, India, and.
³ Department of Biostatistics National Institute of Mental Health & Neurosciences, Bangalore, India.

PMID: 39258542
DOI: 10.1097/WNF.0000000000000612

Abstract

Background: Anti-CD20 monoclonal antibodies have received increasing attention in the past few years in the treatment of multiple sclerosis (MS).

Objectives: This study describes the (i) efficacy and safety of rituximab in people living with MS and (ii) assesses clinical and imaging outcomes following rituximab in MS.

Method: This is a chart review from the MS registry maintained at the institute from a University Hospital in South India.

Result: Eighty-three (M:F, 26:57) people living with MS received rituximab as immunomodulation between 2007 and 2022 with a median follow-up duration of 18 months. Fifty-nine (71%) were classified as relapsing-remitting MS, 16 (19%) were secondary progressive MS, and 8 (10%) were primary progressive MS. Seventy-two (87%) MS patients did not experience any relapse after receiving rituximab. In relapsing-remitting MS patients, the mean annualized recurrence rate dropped from 1.24 ± 1.19 to 0.16 ± 0.37. Infusion-related reaction occurred in 5 (6% of adverse events), urinary infections in 7 (8.4%), systemic infections in 3 (3%), Pneumocystis carinii pneumonia occurred in 1 (1%), and herpes zoster infection in 1 (1%) patient. Mortality was observed in 3 (3.5%) patients. While being on rituximab, 18 (22%) patients had mild COVID-19 illness and they all made complete recovery without any sequalae.

Conclusions: Rituximab is a safe, well-tolerated, easily accessible, inexpensive, and effective therapeutic option for people with MS. Rituximab showed both clinical and radiological improvement after a median follow-up of 1.5 years. None of our patients showed any severe COVID infection nor side effects after receiving COVID vaccination.