Rituximab is more effective and leads to fewer treatment discontinuations in people with multiple sclerosis (MS) than Gilenya (fingolimod) and Tecfidera (dimethyl fumarate), according to real-world data based on two years of therapy.
Rituximab’s effectiveness appeared to be comparable to that of Tysabri (natalizumab), but with fewer treatment discontinuations.
These findings suggest that rituximab may be a better therapeutic option to suppress disease activity and maintain long-term treatment among these patients.
The study, “Rituximab versus natalizumab, fingolimod, and dimethyl fumarate in multiple sclerosis treatment,” was published in the journal Annals of Clinical and Translational Neurology.
Rituximab is an antibody-based therapy that works by killing B-cells, a type of immune cell that drives inflammation in MS and other conditions. It is marketed as Rituxan (by Biogen) in the U.S and as MabThera (by Roche) in Europe, with other brand names used elsewhere in the world.
While not approved for MS itself, rituximab is used off-label as an MS treatment. Data from MS clinical trials and real-world studies suggest that the therapy safely and effectively lessens lesions and relapse rates in both relapsing-remitting MS (RRMS) patients and those with progressive forms of the disease.
However, few studies have compared the effectiveness of rituximab with that of other highly effective, immunomodulatory MS therapies, such as Novartis’ Gilenya and Biogen’s Tysabri and Tecfidera. Furthermore, most of these studies were conducted in Swedish RRMS patients and involved a limited number of participants, preventing accurate conclusions and their generalization.
So, researchers at the University of Colorado’s Rocky Mountain MS Center compared rituximab’s effectiveness and discontinuation patterns with those of Gilenya, Tysabri, and Tecfidera in more than 1,200 MS patients followed at their center.
The team retrospectively analyzed data from people diagnosed with any type of MS and treated with rituximab (182 patients), Gilenya (271 patients), Tysabri (451 patients), and Tecfidera (342 patients) up to two years or until therapy discontinuation.
After several adjustments, the team was able to create well-balanced patient groups for comparison. Therapy effectiveness was evaluated through a composite measure comprising the occurrence of clinical relapse and the presence of active and/or new brain lesions.
Treatment discontinuation was considered when a patient was no longer on the therapy after two years, or initiated any other MS disease-modifying therapy during that time. The main reason for treatment discontinuation also was assessed.
Results showed that rituximab treatment led to significantly greater effectiveness outcomes and fewer discontinuations by twofold to threefold, compared with Gilenya and Tecfidera.