(4) A fourth indication is a treatment of MS in patients with concomitant autoimmune disease. The paper below describes the successful use of rituximab in two pwMS who also had idiopathic thrombocytopenic purpura (ITP); the aim is for rituximab to treat both the MS and the ITP. I have a similar anecdote and have used rituximab in a patient with both active MS and sacroiliitis. Her rheumatologist was keen to treat her with an anti-TNF-alfa drug, which I was strongly against as there is very good data that shows that inhibiting TNF-alpha makes MS worse. A compromise we reached was to treat her with rituximab. She is now 4-years into her rituximab treatment and her MS is NEDA and her sacroiliitis is much improved. This is one case where I have been successful in getting NHS England to agree to funding of rituximab. The reason for this is that she is a unique, or at least a very rare, case and is therefore suitable for an IFR (individual funding request).
OBJECTIVES: The aim of the study was to describe the effectiveness and safety data of rituximab in a group of patients with relapsing-remitting multiple sclerosis (MS) treated with rituximab due to failure of previous treatments or concomitant autoimmune diseases.
METHODS: This is an observational study. Rituximab was considered in case of failure of the second-line therapy, failure of the first-line therapy and a contraindication to second-line therapies, or concomitant autoimmune disease. Relapses, the Expanded Disability Status Scale, the EQ VAS, and magnetic resonance imaging activity were assessed.
RESULTS: This study included 12 patients with relapsing-remitting MS. The mean (range) age of the patients was 35 (19-54) years. Ten patients were treated with rituximab because of treatment failure, and 2 patients were treated with rituximab because of the development of idiopathic thrombocytopenic purpura (ITP). The mean (range) follow-up duration after beginning rituximab was 40 (18-72) months. Rituximab was well tolerated, because no patient experienced serious adverse reactions or discontinued treatment. During treatment with rituximab, no patient suffered a clinical relapse, and magnetic resonance imaging activity was not detected. The Expanded Disability Status Scale scores improved in 11 of 12 patients and remained stable in 1 patient. The EuroQol visual analogue scale scores improved in 8 of 9 patients in whom the EuroQol visual analogue scale was assessed.
CONCLUSIONS: Treatment with rituximab seems to be safe and effective for some patients with relapsing-remitting MS who have failed to respond to first- and second-line therapies and may also be a useful option for patients with concomitant autoimmune disorders.