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Rituximab in patients with primary progressive multiple sclerosis: Results of a randomized double‐blind placebo‐controlled multicenter trial
Author(s) -
Hawker Kathleen,
O'Connor Paul,
Freedman Mark S.,
Calabresi Peter A.,
Antel Jack,
Simon Jack,
Hauser Stephen,
Waubant Emmanuelle,
Vollmer Timothy,
Panitch Hillel,
Zhang Jiameng,
Chin Peter,
Smith Craig H.
Publication year - 2009
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.21867
Subject(s) - rituximab , medicine , placebo , clinical endpoint , randomization , multiple sclerosis , gastroenterology , adverse effect , expanded disability status scale , hazard ratio , surgery , randomized controlled trial , confidence interval , pathology , immunology , lymphoma , alternative medicine
Objective Rituximab, a monoclonal antibody selectively depleting CD20+ B cells, has demonstrated efficacy in reducing disease activity in relapsing‐remitting multiple sclerosis (MS). We evaluated rituximab in adults with primary progressive MS (PPMS) through 96 weeks and safety through 122 weeks. Methods Using 2:1 randomization, 439 PPMS patients received two 1,000mg intravenous rituximab or placebo infusions every 24 weeks, through 96 weeks (4 courses). The primary endpoint was time to confirmed disease progression (CDP), a prespecified increase in Expanded Disability Status Scale sustained for 12 weeks. Secondary endpoints were change from baseline to week 96 in T2 lesion volume and total brain volume on magnetic resonance imaging scans. Results Differences in time to CDP between rituximab and placebo did not reach significance (96‐week rates: 38.5% placebo, 30.2% rituximab; p = 0.14). From baseline to week 96, rituximab patients had less ( p < 0.001) increase in T2 lesion volume; brain volume change was similar ( p = 0.62) to placebo. Subgroup analysis showed time to CDP was delayed in rituximab‐treated patients aged <51 years (hazard ratio [HR] = 0.52; p = 0.010), those with gadolinium‐enhancing lesions (HR = 0.41; p = 0.007), and those aged <51 years with gadolinium‐enhancing lesions (HR = 0.33; p = 0.009) compared with placebo. Adverse events were comparable between groups; 16.1% of rituximab and 13.6% of placebo patients reported serious events. Serious infections occurred in 4.5% of rituximab and <1.0% of placebo patients. Infusion‐related events, predominantly mild to moderate, were more common with rituximab during the first course, and decreased to rates comparable to placebo on successive courses. Interpretation Although time to CDP between groups was not significant, overall subgroup analyses suggest selective B‐cell depletion may affect disease progression in younger patients, particularly those with inflammatory lesions. Ann Neurol 2009;66:460–471