Rituximab for Secondary Progressive MS?

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Multiple sclerosis comes in different varieties:

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Many patients with MS have discrete relapses, which then resolve either partially or completely resolve, and are separated by periods of disease inactivity.  We call this relapsing-remitting (a) or progressive-relapsing (b) disease.

Most of the “disease modifying” drugs currently used in MS work by preventing discrete relapses (and by preventing relapses) they will prevent the progressive acquisition of disability which can accompany each relapse in these types of MS.

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However, there are other MS patients develop progressive disability without discrete relapses.  This can occur after a relapsing remitting phase, so-called secondary progressive MS (c).  Or patients can start right out with progressive disease without any history of discrete relapses, so-called primary progressive MS (d).

Most disease modifying drugs are of little benefit for progressive disease, and treatment has been predominantly symptomatic, with dalfampridine and symptomatic treatments for spasticity.

The chemotherapy drug mitoxantrone was found to have some efficacy for treating secondary progressive MS, but the duration of therapy is limited to 2 years because of toxicity.

New data presented at the fifth Cooperative Meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis this week suggests that the chemotherapeutic agent rituximab may also stabilize or even reverse disability in secondary progressive MS.