Rituximab is safe to use in MS patients and reduces rate of relapse, but its ability to slow

disease progression and its effectiveness compared to other treatments is still uncertain
Castillo-Trivino T, Braithwaite D, Bacchetti P, Waubant E. Rituximab in Relapsing and Progressive Forms
of Multiple Sclerosis: A Systematic Review. PLOS ONE. 2013 Jul 2;8(7):e66308.

Review question
Can the drug rituximab, a monoclonal antibody, be a safe and efficacious treatment for multiple
sclerosis?
Background
Multiple sclerosis is an autoimmune disorder of the nervous system that causes progressive
disability. Current treatments, such as glatiramer acetate, but have only been demonstrated to
be effective in a subset of MS patients. Rituximab is an antibody which targets B cells, a type of
immune cell that is not targeted by existing treatments.
Since B cells have been shown to be involved in MS autoimmunity, it is possible that rituximab
may be a candidate for providing improved clinical outcomes compared to existing drug
therapies.
How the review was done
The researchers searched for clinical studies of rituximab in a number of databases including
MEDLINE, EMBASE, and ClinicalTrials.gov. The search screened for studies which measured
disability progression, relapse rate, side effects, and MRI outcomes. The researchers excluded
trials of rituximab for neuromyelitis optica, a similar but pathologically distinct disorder.
209 unique articles were identified from the database search. Of these, 4 were included in the
final review. The review was funded in part by the Spanish Society of Neurology, the Carlos III
Institute of Health, and the Multiple Sclerosis International Federation.
What the researchers found
The studies generally showed that rituximab caused a greater number of mostly mild to
moderate adverse effects compared to placebo. However, severe adverse effects were rare.
The effect of rituximab on disability progression was not clear in the studies reviewed. However,
it appeared to be successful in reducing the rate of relapses as well as reducing the number of
MS-associated lesions in brain MRIs.
The authors commented that the studies reviewed varied in patient recruitment as well as
outcome measurement, and that this likely contributed to the significant disparities seen in the
studies results.

Conclusion
The evidence suggests that rituximab is reasonably safe to use in MS patients. It appears to be
successful in reducing relapse rate and reduces the number of MRI brain lesions, but its effect
on disability progression cannot be confirmed.
More evidence comparing rituximab to other standard MS treatments is required to better
understand the therapeutic effectiveness of rituximab in MS therapy.