Efficacy and Toxicity of Rituximab in Multiple Sclerosis

Abstract

Context: Bothersome relapses or conditions that damage function in patients with multiple sclerosis (MS) need a well-focused strategy of appropriate management to return patients’ function and decrease the disability. A large number of clinical studies are being accompanied to evaluate the effectiveness and adverse effects of rituximab. Deteriorations assist as significant signs of disorder activity. In such conditions B cell-depleting regimens such as rituximab may be considered. To attain major motivation and gather talented satisfying evidence, strong review articles and research could try to focus on the best time to prescribe rituximab in MS. Evidence Acquisition: Clinical trials and review articles to achieve efficacy and safety of rituximab in MS were searched. The current study first offered an outline of the rituximab pharmacokinetics parameters in overall, suggested mechanisms of action that contribute to the beneficial effects of rituximab and the perfect timing of prescription-based therapies for MS. Results: A total of 647 articles (1997 - 2015) were found related to efficacy, safety and pharmacokinetics parameters of rituximab in MS. Six articles (3; 2009, 1; 2010 and 2; 2011) were related to the use of rituximab in: primary progressive MS, autoimmune disease, refractory and autoimmune pediatric disease, 52-week phase II clinical trials and relapsing neuromyelitis optica were studied further. In phase II clinical trials based on blinded radiological end-points pharmacotherapy using rituximab suggested to be effective. There is also report regarding to less increase in T2 lesion volume (P < 0.001) after two years of rituximab management. There was no change in brain volume (P = 0.62). There was a delay in patients less than 51 years related to the disease progression. Adverse effects were reported in < 5% of patients with rituximab. Also it has been reported that in 28 out of 30 patients with neuromyelitis optica, there was a significant reduction in the rate of relapse over two years. Conclusions: The current study aimed to evaluate the efficacy of rituximab in patients with MS. Due to inter and intra individual variability in disease presentation and its progression, rituximab should be prescribed cautiously.