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Rituximab (Rituxan/Truxima) for Multiple Sclerosis explained by Neurologist
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- Опубліковано 14 сер 2024
- Start watching to learn about Rituximab for Multiple Sclerosis
Comment or ask questions below. I would be happy to answer.
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Dr. Brandon Beaber is a board-certified neurologist with subspecialty training in multiple sclerosis and other immunological diseases of the nervous system. He is a partner in the Southern California Permanente Medical Group and practices in Downey, California (South Los Angeles). He has several publications on MS epidemiology and has participated in clinical trials for MS therapeutics. You can follow him on twitter @Brandon_Beaber where he regularly posts about MS news and research.
Follow me on twitter: / brandon_beaber
Music: INNER GRACE - Copyright 2018 Wilton Vought Source: Really Really Free Music Link: • Video
The video material by Dr. Brandon Beaber is general educational material on health conditions and is not intended to be used by viewers to diagnose or treat any individual's medical condition. Specifically, this material is not a substitute for individualized diagnostic and treatment advice by a qualified medical/health practitioner, licensed in your jurisdiction, who has access to the relevant information available from diagnostic testing, medical interviews, and a physical examination. To the extent that Dr. Beaber endorses any lifestyle change, behavioral intervention, or supplements, the viewer should consult with a qualified healthcare professional to determine the safety and efficacy of the intervention in light of their individualized information.
Selected sources:
1) Ann Neurol. 2008 Mar;63(3):395-400. doi: 10.1002/ana.21363; Rituximab in relapsing-remitting multiple sclerosis: a 72-week, open-label,
phase I trial; Bar-Or A1, Calabresi PA, Arnold D, Markowitz C, Shafer S, Kasper LH, Waubant E, Gazda S, Fox RJ, Panzara M, Sarkar N, Agarwal S,
Smith CH; Ann Neurol. 2008 Jun;63(6):803. Arnlod, Douglas [corrected to Arnold, Douglas].
2) B-Cell Depletion with Rituximab in Relapsing-Remitting Multiple Sclerosis; N Engl J Med 2008; 358:676-688; Stephen L. Hauser, M.D.,
Emmanuelle Waubant, M.D., Ph.D., Douglas L. Arnold, M.D., Timothy Vollmer, M.D., Jack Antel, M.D., Robert J. Fox, M.D., Amit Bar-Or, M.D.,
Michael Panzara,
3) The Cochrane review: Rituximab for relapsing-remitting multiple sclerosis; Cochrane Database Syst Rev. 2013;12:CD009130; He D1, Zhou H,
Han W, Zhang S.
Primary progressive multiple sclerosis
4) Rituximab in patients with primary progressive multiple sclerosis: results of a randomized double-blind placebo-controlled multicenter trial.;
Hawker K1, O'Connor P, Freedman MS, Calabresi PA, Antel J, Simon J, Hauser S, Waubant E, Vollmer T, Panitch H, Zhang J, Chin P, Smith CH;
OLYMPUS trial group. Ann Neurol. 2009 Oct;66(4):460-71. doi: 10.1002/ana.21867.
Theoretical basis:
5) “The evidence for a role of B cells in multiple sclerosis”; Neurology. 2012 Mar 13;78(11):823-32. doi: 10.1212/WNL.0b013e318249f6f0;
Disanto G1, Morahan JM, Barnett MH, Giovannoni G, Ramagopalan SV.
6) ”B cell depletion therapy ameliorates autoimmune disease through ablation of IL-6-producing B cells”; Barr TA1, Shen P, Brown S,
Lampropoulou V, Roch T, Lawrie S, Fan B, O'Connor RA, Anderton SM, Bar-Or A, Fillatreau S, Gray D. ;J Exp Med. 2012 May 7;209(5):1001-10.
doi: 10.1084/jem.20111675. Epub 2012 Apr 30.
7) “B cells in MS and NMO: pathogenesis and therapy.” Semin Immunopathol. 2014 May;36(3):339-50. doi: 10.1007/s00281-014-0424-x. Epub
2014 May 16.; Krumbholz M1, Meinl E.
Other:
8) “Rituximab Use in Pediatric Central Demyelinating Disease.“ Pediatr Neurol. 2014 Feb 15. pii: S0887-8994(14)00135-0. doi:
10.1016/j.pediatrneurol.2014.02.007. [Epub ahead of print]; Beres SJ1, Graves J2, Waubant E3.
9) FDA indication: www.fda.gov/Dru...
10) product label: www.accessdata....
11) “Unusual viral infections (progressive multifocal leukoencephalopathy and cytomegalovirus disease) after high-dose
chemotherapy with autologous blood stem cell rescue and peritransplantation rituximab.”; Blood. 2002 Feb 15;99(4):1486-8.;
Goldberg SL1, Pecora AL, Alter RS, Kroll MS, Rowley SD, Waintraub SE, Imrit K, Preti RA.
12) “Progressive Multifocal Leukoencephalopathy: a rare infectious complication following allogeneic hematopoietic cell
transplantation (HCT)”Gregory P. Kaufman1,*, Allen J. Aksamit2, Christopher J. Klein2, Eunhee S. Yi3, David R. DeLone4 and
Mark R. Litzow1,5; European Journal of Haematology Volume 92, Issue 1, pages 83-87, January 2014
Great explanation of the drug and it's impact on MS. I'm no longer hesitant on proceeding ahead with treatment.
Good 👍 I’m getting my first infusion as I Tex 😎👍🤩
How everything went?
@@facemango4780hello i am ms patient soon switching to rituximab can you pls tell me how you are doing with the drug...over all health? Did you had any hairloss ??
@@dragonfire3727hello did you had rituximab ?? Please let me know how you are doing ?
Awesome, I got diagnosed with MS a year ago, but have had the symptoms for 2 years by now.
I've tried to get any information from the doctors in Sweden but they are extremely tight-lipped.
I've hade 2 doses of intraveneus rituximab now though, first was 1mg and second was 0.5 mg and I'm due for 2 more on a 6 month interval, and is due to have a 2nd brainscan next week.
My symptoms are mild though, and I only experience numbness in one arm. I can still ride a bike, but fiddling with keys and coins is a chore.
Thank you for watching! See this video for information about Ocrevus, a similar drug which is also an anti-CD20 b-cell depleting agent: ua-cam.com/video/mCVVvq7Aov0/v-deo.html
Explain about rituximab in apla syndrome case
The best presentation yet. Thank you.
Much needed information for MS patients. I eventually became RRMS patient after first diagnosed 5 years back. I have been on Avonex Interferon beta, later DMF and now on Rituximab. So when you showed graph of MS patients stay on Rituximab and leaving other medications such as INJ, DMF and NTZ, I could relate to this graph. My only concern is long term use of Rituximab. I am on RTX infusion from more than year now.
There is is risk of low immunoglobins and infections with long term use. Some doctors extend the interval of rituximab to decrease this risk.
@@DrBrandonBeaber thank you so much for being such an informative. Doctor's in India usually don't explain much and leave MS patient on their own.
Thanks a lot!! I just had rituximap last week, waiting for the second one next week, definitely will follow your VDO and I’ll let you know once I can. I’m living in Thailand. 😊🙏
I hope my insurance approves me for rituximab. I would like to start my first MS treatment with this one. Thank you for your video.
Excellent, helpful info. Thanks DR.
You're very welcome.
Dx in 2000, started with Avonex right away for 8 years. Tolerated it well and it seemed to wear off. Decided to go with Tysabri and it worked quite well, stayed on it even though I later found I was JCV+. As time went on, flares started up again after 10 years of Tysabri and the risk for PML was just not worth it anymore. So far after two years I am tolerating it well. Had my last on this week with IV Solumedrol, oral Tylenol and Benadryl prior to Rituxan. Slow IV drip and no throat burning anymore.
Hello! I have MS and going to have my first infusion of Rituximab in two weeks. I've been on Tysabri and JCV+ as well. Although my medicians say it is safe, I'm a bit worried 'cause I've read there's also a risk for PML with Rituxan.
Have you heard about it? Do you keep checking JCV levels?
How are you now, one year after this comment?
Hope you're well. 🙏
@@rafaela7427 I have read the insert and my doc gave me risk/benefit informed consent. No problems so far and I do believe they check for the antibodies regularly. I figure the risk is worth it. Unfortunately my stage of the illness I have had slight relapses
You had ms for 25 years are you still mobile?
@@dragonfire3727 yep
@@titusflavius5668 that's amazing, it really give me so much hope thank you very much for responding
Thank you very much for this video. I am currently studying this topic for my thesis in Portugal. Could you make a new video with the updates in this study? that would be lovely! 🤩 thank you!
What do you know/think about the article in Multiple Sclerosis News Today that said that after stopping one of the B-cell depleting medications (I don’t remember if it was Ocrevus or rituximab) the B-cells return with more aggressive inflammatory qualities. That’s me paraphrasing. I read the web article briefly a few weeks ago. Two months ago I started Tecfidera instead of Rituximab (because of COVID). This news is potentially very disturbing given that rituximab may be in my future. Thanks! I appreciate the information that you provide.
Thank you for all of your videos, Dr. Beaber! They are very helpful and informative. Do you find that patients have a hard time getting insurance to cover Rituxan for MS since it's not an approved therapy? Have you had patients who had inflammatory arthritis along with their MS that were treated with this one drug? Seems like it would work well if you had patients with both types of issues, and that insurance might be more apt to cover it in those circumstances.
The question about insurance is highly variable by region and individual insurance policy. Patients with insurance through the affordable care act often have copays for clinically administered medications which can be a problem. For anyone with MS, I would suggest reviewing the insurance policy very carefully (go to "benefit headings" and then "outpatient services" and then "clinic administered drugs and administration.") You want it to say "No payment." I have had some patients with both rheumatoid arthritis and multiple sclerosis who have successfully treated both conditions with rituximab
Thank you Dr Beaver. I was on Ocrevus but I had to Switch to Rituzimab, because I am now With social security in my country, are there any side effects or studys that dont recomend this change?
Great presentation. I’m waiting for approval from my insurance company for treatment for NMOSD Curious if you work with patients with NMOSD?
Excellent video! Do you have any data regarding B-cell depleting therapies (rituxan/ocrevus) and their effect on longer term disease progression? Since my fiancé got diagnosed with MS I've read every medical report I can find on MS treatment, but from what I can tell part of the data on progression from RRMS to SPMS seems a bit outdated. Her doctor is leading a study in Norway called MS-OVERLORD and he saw us both the day she got the diagnosis. As part of the study she will receive either Rituximab or Ocrelizumab. When we asked him how he thought this would affect her in the future he told us not to worry about it. With the treatment patients with MS get today she will be able to live a normal life for the rest of her life. This is not a quote, but it isn't far from it either. But I've yet to find a single medical article that says that we think we can stop RRMS to progress into SPMS. If you could enlighten me a bit on this I would be very grateful. And keep up the good work :)
There is some evidence that Ocrevus Reduces Cane Use by 50% in 6-Year Follow-Up Data (in relapsing MS from the OPERA I/II studies): ua-cam.com/video/-foef71HXd0/v-deo.html Unfortunately, I don't think it is possible to guarantee someone they will never develop progressive MS.
If someone has a heavy family history for cancer, would Rituximab be better than Ocrevus?
Great video! I am curious about studies and/or thoughts comparing Ocrevus and Rituxan. My understanding is Ocrevus is one molecule removed from Rituxan. How do you choose one vs. the other (besides insurance coverage/copay assistance at this point)?
There are no head to head studies between different anti-CD20 agents. Rituximab is a chimeric protein containing both mouse and human components. Ocrevus is humanized and could theoretically have a lower risk of anti-drug antibodies, though the infusion reactions are usually due to b-cell lysis rather than due to anti-drug antibodies. Some critics of ocrelizumab state that it may be "overdosed," increasing the risk of infection without additional benefit (a Swedish series suggests that lower doses of rituxan [500mg] may be equally effective with lower risk). There is also a possible link between Ocrevus and breast cancer as I stated in the video.
Dr, Beaber I know my question is unrelated to the video. But I have been on Ocrelizumab for three years now. The first two year CORD study through Columbia Medical center. My question to you is if I were to use HGH how would this effect the use of Ocrelizumab that I am on?
Thankyou for all that great information. I am on tecfidera since the past 6 years with relapses every once in a while treated with steroids.
But my very last relapse around 6 months ago didn't respond to steroids. I have been asked to switch to rituximab as the doctors think tecfidera isn't working. Pls advise regarding the same..doesn't rituximab have more side effects than tecfidera? What is the best drug available for MS?
Thank you Dr Beaber for such an enlightening video. You are so thorough in your explanations, which is something I find very helpful.
I am due to commence Rituximab soon (to control both my MS and Lupus) and have an appointment with my Neurologist in a couple of weeks time, so this video was very much needed and appreciated. I also happen to have Addison's disease and one of my main concerns about this treatment is the potential side effects of sickness; is this something you've seen in your patients? I'm sure you will understand my hesitation on commencing treatment which may result in sickness of any kind but certainly from your video I can see the positive benefits it could offer me.
Thank you again for your brilliant videos. I look forward to more. Take care. 😊
great video, a question if I am positive for the jc virus and I have not given natalizumab, is there a greater chance of PML simply because I have the jc positive? thank you
Why is Rituximab not approved? Shouldn't it be approved by the FDA before we take this every expensive drug ($6k annually out-of-pocket for me)?
No one has applied for FDA approval. The approval process is extremely expensive and would not be pursued for an off-patent drug.
Hello Doctor, thank you for the excellent presentation!
I wanted to ask about the link between Rituximab and elevation in lipid levels. It's been shown to occur in patients being treated for other immune-mediated disorders such as RA and Lupus, so I was curious if this is also seen in MS patients being treated with rituximab, and the short and long term clinical implications of this effect, if any.
Thank you very much, you have been very helpful.
BUT, then...it has a HIGH rate of neuropathy side effects? So...WHY?
Hi Doctor,
My father is experiencing some serious Nuerological issues and right now he is not able to speak , walk and even his vission seems to be affected. We did the brain biopsy and the result was suggesting a inflammatory pathology. Right now he is administerd with 500mg first dose of Rituximab. Is there any possibility of improvement Doctor
Such a great and informative video, thanks Dr!
Have you seen any patients or do you know about any studies that confirm the safety of using Rituximab + Secukinumab (cosentyx) combined?
Cheers and thanks for keeping the great work up!
I am not aware of any studies on this specific combination. There is a case report of someone who took both medications for different conditions: pubmed.ncbi.nlm.nih.gov/30901703/
If you had the Hep B antibodies show up in your blood draw from a past infection, can you still have the treatments or is it dangerous?
Thank you for making this and other videos with evidence and facts!! We really appreciate it! I'm a Kaiser patient that was recently diagnosed, they want me to start this medication as a first line defense. Is this common?
Medication being Rituximab if I was clear.. ty
Very good information
Getting ready for my first infusion, will my recent covid vaccination interfere with process? Thanks
B cell depleters such as rituximab can reduce antibody response to vaccines, so many doctors are recommending waiting until after vaccination to get the treatment, depending on the situation. Of course, I can't give you personalized advice here.
Nice video! Nice review of this anti-CD20!
Thanks!
Very informative Dr.! Thank you for all the great videos!
It sounds like doctors may be hesitant to administer iv immunoglobulins for patients who develop low IG counts while on Rituxan. Why might this be?
I'm not sure exactly. Intravenous Immunoglobins do have potential side effects such as kidney failure, allergies, and clotting events. I had one patient developed central retinal artery occlusion leading to permanent vision loss in one eye due to IVIG. There aren't specific guidelines for this as far as I know.
What are the reasons for prescibing rituxamab over ocrevus or viceversa? Tnx
Dr Beaber, great video thank you. Could you explain why rituximab might cause fatigue and weakness?
It can cause infusion reactions and sometimes people can get prolonged side effects after the infusion ("serum sickness,") but keep in mind that the half life of rituximab is around 3 weeks, so I would not expect it to cause side effects other than immunosuppression several months later.
@@DrBrandonBeaber thank you so much for replying! It’s been two months since dose 2 I guess my immune system is busy working it out.
@@DrBrandonBeaber maybe that explains raised polyclonal gamma globulins?
Hello Dr Brandon
Rituximab is desame effect of Rixathon or not?
Thank you so much for this video!! I would like to know if solumedrol must be given with this infusion? If not, could there be issues?
For people who tolerate it well and do not have an infusion reaction (and have side effects with steroids), I have given it without solumedrol. Talk to you own provider.
Thank you for the Video, I would like to know the effect on PV patients. Can you please share more information on PV
Sorry. This would be beyond my area of expertise.
What if any are the differences between ocrevus vs. Rituxan?
I know Rituximab and Ocrelizumab have very similar effects, as I understand Ocrelizumab is somehow adapted to beter suit M.S. treatment. But I can't find any information on what these adaptions actually are. Especially since one is on-label and the other off-label. The cost difference probably will be huge.
It's really impossible for this type of drug to be "adapted" to a particular disease. All these drugs do is break open b-lymphocytes, killing them...virtually all of them. The drug doesn't know whether the b-lymphocyte is a normal b-cell, an autoreactive b-cell contributing to autoimmune disease, or a cancerous cell. Rituximab has been used to treat rheumatoid arthritis and many other autoimmune diseases, so it is unreasonable to assume that Ocrevus is somehow better suited to autoimmune disease while Rituxan is better for lymphoma.
@@DrBrandonBeaber So may i conclude there is no diffence between Ocrelizumab and Rituximab?
@@TheSokwe They work in the same way, but there are some slight differences. They are structurally different, so it is possible to develop antibodies against one and not the other. There is also evidence that ocrelizumab is stronger and depletes b-cells at lower doses (though it is not clear whether this is beneficial or harmful).
@@DrBrandonBeaber interesting, thanks for your response.
Good night Dr. My name is Fernando and I'm from Brazil. I will start treatment for multiple sclerosis with Rituximab. I watched several of your videos. I would like to know if there is a recent article regarding the ideal initial dosage for treatment (500 or 1000mg every 6m) TKS!
oi Fernando, tudo bem? Tbm tenho Em e estou prestes a começar o Rituximabe. Estou um pouco apreensiva pq tenho JCV positivo e alto.
Vc chegou a usar o natalizumabe antes? Viu algo sobre LEMP nos artigos que leu?
@@rafaela7427 eu nem comecei com o natalizumabe. Jc deu 4,9. Estava no tecfidera. Não achei relatos de LEMP de quem está tomando o rituximabe. A cada 6 meses vou tentar fazer só 500mg. Para conseguir ficar tomando por mais tempo e ir acompanhando nos exames.
@@fernandoalmeida6395 Vc já fez a primeira infusão do Rituxi? Eu li as bulas e existem sim o risco e casos de Lemp. Confirmei com os meus médicos. Mesmo assim, optei por fazer. Temos um grupo no wpp (são poucas pessoas) com EM e usando o Rituxi há anos. Se tiver interesse em participar, só falar!
When rituximab/mathbera is recommended, the second dose should be given 5 months after the first dose?
Often the 2nd dose is given 6 months later.
@@DrBrandonBeaber My first dose was December 9, 2022. I calculate the second dose on June 9, 2023. Or not?
@@adaprifti602 I can't give you personal advice here.
Renal , will it happen if I am already in stage four ?
Dear sir can a male under rituximab father a child. What is the effect on spermatogenesis.
I have many male patients who have fathered children while taking rituximab. I am not aware of any specific effect on spermatogenesis. This study in mice seems to suggest no significant effect: www.jnsmonline.org/article.asp?issn=2589-627X;year=2020;volume=3;issue=1;spage=66;epage=70;aulast=Al-Mogairen Talk to your own provider.
Pls agar koi hindi mai comment kr ke bta skta hai toh pls bta do kis use mai aata hai injection mai pls 🙏
Is rituximab advisable for 16-year-old adolescents with MS?
Sorry but I can't give personal advice here.
@@DrBrandonBeaber I live in sweden. If possible can I leave you my email? I definitely want a consultation with you
Kako doći do ovog leka .Imam MS 17 god
Sir dose
?
Sir my wife was nmo 6 months ago
Doctor 500mg with rituximab injection
Gave two injections,
Sir, I am telling you how many more days you have to give this injection
I wanna be treated by you 🥺 I would change my country for that
Telugu vedios
This ended my dads life.
What do you mean?