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Association of Rituximab Treatment With Disability Progression Among Patients With Secondary Progressive Multiple Sclerosis.


ABSTRACT:

Importance

Therapeutic options for patients with secondary progressive multiple sclerosis (SPMS) are limited.

Objective

To analyze disability progression in patients with SPMS treated with rituximab compared with matched control patients never treated with rituximab.

Design, setting, and participants

This retrospective cohort study analyzed data obtained from patients with SPMS at 3 multiple sclerosis centers located in Basel and Lugano, Switzerland, and Amsterdam, the Netherlands, from 2004 to 2017. Patients were included for analysis if they had received a diagnosis of SPMS, were treated (57 eligible; 54 included) or never treated (504 eligible; 59 included) with rituximab, and had at least 1 follow-up visit. The variables used for propensity score matching were sex, age, Expanded Disability Status Scale (EDSS) score, and disease duration. Follow-up duration was up to 10 years, with a mean (SD) of 3.5 (2.6) years for rituximab-treated patients and 5.4 (2.4) years for controls in the total cohort and a mean (SD) of 3.5 (2.7) years for rituximab-treated patients and 4.8 (2.2) years for controls in the matched cohort.

Exposures

Comparing EDSS score progression in patients with SPMS (treated with rituximab vs not treated with rituximab) using propensity score matching.

Main outcomes and measures

The primary end point was progression of EDSS score after baseline, and the secondary end point was time to confirmed disability progression.

Results

After 1:1 propensity score matching, 44 matched pairs (88 patients) were included in the analysis. At baseline, patients treated with rituximab had a mean (SD) age of 49.7 (10.0) years, mean (SD) disease duration of 18.2 (9.4) years, and mean (SD) EDSS score of 5.9 (1.4), and 26 (59%) were women, whereas controls had a mean (SD) age of 51.3 (7.4) years, mean (SD) disease duration of 19.4 (8.7) years, and mean (SD) EDSS score of 5.70 (1.29), and 27 (61%) were women. In the covariate-adjusted analysis of the matched set, patients with SPMS who were treated with rituximab had a significantly lower EDSS score during a mean (SD) follow-up of 3.5 (2.7) years (mean difference, -0.52; 95% CI, -0.79 to -0.26; P?Conclusions and relevanceIn this study, patients with SPMS treated with rituximab had a significantly lower EDSS score for up to 10 years of follow-up and a significantly delayed confirmed progression compared with matched controls, suggesting that B-cell depletion by rituximab may be therapeutically beneficial in these patients. A prospective randomized clinical trial with a better level of evidence is needed to confirm the efficacy of rituximab in such patients.

SUBMITTER: Naegelin Y 

PROVIDER: S-EPMC6439730 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

Association of Rituximab Treatment With Disability Progression Among Patients With Secondary Progressive Multiple Sclerosis.

Naegelin Yvonne Y   Naegelin Peter P   von Felten Stefanie S   Lorscheider Johannes J   Sonder Judith J   Uitdehaag Bernard M J BMJ   Scotti Barbara B   Zecca Chiara C   Gobbi Claudio C   Kappos Ludwig L   Derfuss Tobias T  

JAMA neurology 20190301 3


<h4>Importance</h4>Therapeutic options for patients with secondary progressive multiple sclerosis (SPMS) are limited.<h4>Objective</h4>To analyze disability progression in patients with SPMS treated with rituximab compared with matched control patients never treated with rituximab.<h4>Design, setting, and participants</h4>This retrospective cohort study analyzed data obtained from patients with SPMS at 3 multiple sclerosis centers located in Basel and Lugano, Switzerland, and Amsterdam, the Neth  ...[more]

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