Journal
MULTIPLE SCLEROSIS JOURNAL
Volume 27, Issue 8, Pages 1230-1239Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/1352458520952036
Keywords
Multiple sclerosis; rituximab; de-escalation; neurofilament light; immunoglobulin; infections
Categories
Funding
- Neurocenter of Southern Switzerland
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De-escalating rituximab dose from 1000 to 500 mg/6 months in multiple sclerosis is safe and leads to clinical and radiological stability over 12 months. Serum NfL concentration remains stable, but higher rituximab load negatively affects IgG concentrations, with IgG deficient patients at higher risk of infections.
Background: Phase II and observational studies support the use of rituximab in multiple sclerosis. Standard protocols are lacking, but studies suggest comparable efficacy between low- and high-dose regimens. Objective: To evaluate effectiveness and safety of de-escalating rituximab dose from 1000 to 500 mg/6 months in multiple sclerosis. Methods: Patients were switched from rituximab 1000 to 500 mg/6 months and prospectively followed for 12 months. Relapses, disability, occurrence of brain/spinal magnetic resonance imaging (MRI) lesions, serum neurofilament light chain (NfL), CD19(+) B cell, and IgG concentrations were analyzed. Results: Fifty-nine patients were included (37 relapsing-remitting, 22 secondary progressive). No relapses occurred, with no difference in expanded disability status scale (EDSS) between baseline (4 (2.5-4.5) and 12 months (3.5 (2.5-5.5)p = 0.284). Overall, three new T2 lesions appeared during follow-up. NfL concentration was stable between baseline (7.9 (5.9-45.2) pg/mL) and 12 months (9.1 (5.9-21.3) pg/mL,p = 0.120). IgG concentrations decreased with greater rituximab load (coefficient = -0.439,p = 0.041). IgG deficient patients had greater risk of infections (OR = 6.27, 95% CI = 1.71-22.9,p = 0.005). Conclusion: De-escalating rituximab dose from 1000 to 500 mg/6 months is safe, results in clinical and radiological stability, and does not affect serum NfL over 12 months. Rituximab load negatively influences IgG concentrations, and IgG deficient patients are at higher risk of infections.
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