Intrathcal treatment with rituximab in progressive MS – an phase 1b study:
The study show that 1 of 7 had a treatment effect after one year, none had any differences in 6 biomarkers and one had a bacterial meningitis that was treated successfully.
The role of B cells in MS:
Faiez Al Nimer and Fredrik Piehl together with a group in Zürich have published an article in Cell about memory B cells in MS:
You can read more about the article here (in Swedish): http://www.neurologiisverige.se/ny-forklaring-till-uppkomsten-av-ms/
In short, autoproliferation by CD4 T cells in MS, especially in DRB1*15:01 positive patients, is driven by memory B cells that are depleted by rituximab treatment. After 3-4 doses rituximab it seems like the memory B cell pool is eliminated and the question is how long lasting the effect might be then. Observations from both Umeå and Stockholm indicates that the risk for new disease activity over 2-3 years is very low, as one see with induction treatments with alemtuzumab and cadribine. This is of potential clinical importance, for example regarding sensitivity against infections and regarding vaccinations. If we see that your have a poor take on vaccination due to rituximab treatment one might be able to let the B cells return for a bit longer to improve the vaccination protection.
Combination of MRI and biomarkers in CSF can be used to predict secondary progressive disease.
Joachim Burman has together with colleagues in Uppsala published the following article:
In short, they have with the help of metabolites and protein analyses in CSF together with MRI data identified SPMS at an early stage. With 11 variables one could separate RRMS and SPMS and with an additional 4 markers even progression.
- See comments in Dagens medicin with Jonatan Salzer, Umeå university
- See comments in Forbes
- See comments by National MS society
- See comments by Gavin Giovanonni