Experience at a tertiary level-of-care center in the Use of Rituximab for Patients Diagnosed with Primary Progressive Multiple Sclerosis
Roberto Rodríguez-Rivas1, Montserrat Massó-Paez2, Jose de Jesus Flores1, Teresita Corona Vazquez3, Veronica Rivas1
1Clínica de Enfermedades Desmielinizantes, Instituto Nacional de Neurología y Neurocirugía. Manuel Velazco Suárez., 2Tecnológico de Monterrey, 2. Facultad de Medicina y ciencias de la salud, 3Jefatura de estudios de posgrado., Universidad Nacional Autónoma de México
Objective:
Analyze the evolution of patients with Rituximab as a treatment option for PPMS and compare it to the use of other non-approved treatments and Ocrelizumab.
Background:
Multiple sclerosis (MS) is a demyelinating disease with multiple phenotypes, being primary
progressive multiple sclerosis (PPMS) the least common one. In Mexico, we do not have available
all approved medications to treat this form. This is more evident for PPMS, because even being a
highly specialized medical center, we only have Ocrelizumab, a monoclonal anti-CD20+ antibody,
for these patients.
Design/Methods:
A cohort of patients from the demyelinating diseases clinic of the National Institute of Neurology and
Neurosurgery with diagnosis of MS was analyzed from the years 2008 to 2022. An EDSS paired
analysis within each treatment group was realized, and it was further adjusted with ANCOVA to the
initial EDSS and time of evolution.
Results:
Of the 1248 patients with MS, 58 were diagnosed with PPMS (4.67%), of these, 44 were without
any treatment since diagnosis, 9 were on Rituximab, 6 on Ocrelizumab and 12 were receiving other
non-approved treatments. The mean time of follow-up was 13.2 years. The groups with Rituximab
(+0.611 p=0.33) and Ocrelizumab (-0.25 p=0.51) did not showed a significant increase in the EDSS.
The patients without treatment or with non-approved medications an increase in the EDSS of
0.7656 (0.02-1.5 p=0.042), with non-approved treatments an increase of 1.682 (0.55-2.80 p=0.007)
was seen. The ANCOVA adjusted for age, time of disease evolution and initial EDSS shows
differences between the groups, associating 6% of the variance in the change of EDSS to the
treatment (p=0.0001).
Conclusions:
Patients receiving anti-CD20+ monoclonal antibodies have less progression in disability at least during the follow-up years although this effect is smaller than with Ocrelizumab. The use of non-approved treatments could be related to an even higher worsening of the EDSS.