Rituximab (Rituxan/Truxima) for Multiple Sclerosis explained by Neurologist

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Dr. Brandon Beaber is a board-certified neurologist with subspecialty training in multiple sclerosis and other immunological diseases of the nervous system. He is a partner in the Southern California Permanente Medical Group and practices in Downey, California (South Los Angeles). He has several publications on MS epidemiology and has participated in clinical trials for MS therapeutics. You can follow him on twitter @Brandon_Beaber where he regularly posts about MS news and research.
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The video material by Dr. Brandon Beaber is general educational material on health conditions and is not intended to be used by viewers to diagnose or treat any individual's medical condition. Specifically, this material is not a substitute for individualized diagnostic and treatment advice by a qualified medical/health practitioner, licensed in your jurisdiction, who has access to the relevant information available from diagnostic testing, medical interviews, and a physical examination. To the extent that Dr. Beaber endorses any lifestyle change, behavioral intervention, or supplements, the viewer should consult with a qualified healthcare professional to determine the safety and efficacy of the intervention in light of their individualized information.

Selected sources:

1) Ann Neurol. 2008 Mar;63(3):395-400. doi: 10.1002/ana.21363; Rituximab in relapsing-remitting multiple sclerosis: a 72-week, open-label,
phase I trial; Bar-Or A1, Calabresi PA, Arnold D, Markowitz C, Shafer S, Kasper LH, Waubant E, Gazda S, Fox RJ, Panzara M, Sarkar N, Agarwal S,
Smith CH; Ann Neurol. 2008 Jun;63(6):803. Arnlod, Douglas [corrected to Arnold, Douglas].

2) B-Cell Depletion with Rituximab in Relapsing–Remitting Multiple Sclerosis; N Engl J Med 2008; 358:676-688; Stephen L. Hauser, M.D.,
Emmanuelle Waubant, M.D., Ph.D., Douglas L. Arnold, M.D., Timothy Vollmer, M.D., Jack Antel, M.D., Robert J. Fox, M.D., Amit Bar-Or, M.D.,
Michael Panzara,
3) The Cochrane review: Rituximab for relapsing-remitting multiple sclerosis; Cochrane Database Syst Rev. 2013;12:CD009130; He D1, Zhou H,
Han W, Zhang S.

Primary progressive multiple sclerosis

4) Rituximab in patients with primary progressive multiple sclerosis: results of a randomized double-blind placebo-controlled multicenter trial.;
Hawker K1, O'Connor P, Freedman MS, Calabresi PA, Antel J, Simon J, Hauser S, Waubant E, Vollmer T, Panitch H, Zhang J, Chin P, Smith CH;
OLYMPUS trial group. Ann Neurol. 2009 Oct;66(4):460-71. doi: 10.1002/ana.21867.

Theoretical basis:

5) “The evidence for a role of B cells in multiple sclerosis”; Neurology. 2012 Mar 13;78(11):823-32. doi: 10.1212/WNL.0b013e318249f6f0;
Disanto G1, Morahan JM, Barnett MH, Giovannoni G, Ramagopalan SV.

6) ”B cell depletion therapy ameliorates autoimmune disease through ablation of IL-6-producing B cells”; Barr TA1, Shen P, Brown S,
Lampropoulou V, Roch T, Lawrie S, Fan B, O'Connor RA, Anderton SM, Bar-Or A, Fillatreau S, Gray D. ;J Exp Med. 2012 May 7;209(5):1001-10.
doi: 10.1084/jem.20111675. Epub 2012 Apr 30.

7) “B cells in MS and NMO: pathogenesis and therapy.” Semin Immunopathol. 2014 May;36(3):339-50. doi: 10.1007/s00281-014-0424-x. Epub
2014 May 16.; Krumbholz M1, Meinl E.

Other:

8) “Rituximab Use in Pediatric Central Demyelinating Disease.“ Pediatr Neurol. 2014 Feb 15. pii: S0887-8994(14)00135-0. doi:
10.1016/j.pediatrneurol.2014.02.007. [Epub ahead of print]; Beres SJ1, Graves J2, Waubant E3.

9) FDA indication: http://www.fda.gov/Drugs/DrugSafety/P...

10) product label: http://www.accessdata.fda.gov/drugsat...
11) “Unusual viral infections (progressive multifocal leukoencephalopathy and cytomegalovirus disease) after high-dose
chemotherapy with autologous blood stem cell rescue and peritransplantation rituximab.”; Blood. 2002 Feb 15;99(4):1486-8.;
Goldberg SL1, Pecora AL, Alter RS, Kroll MS, Rowley SD, Waintraub SE, Imrit K, Preti RA.

12) “Progressive Multifocal Leukoencephalopathy: a rare infectious complication following allogeneic hematopoietic cell
transplantation (HCT)”Gregory P. Kaufman1,*, Allen J. Aksamit2, Christopher J. Klein2, Eunhee S. Yi3, David R. DeLone4 and

Mark R. Litzow1,5; European Journal of Haematology Volume 92, Issue 1, pages 83–87, January 2014