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A 2-year clinical trial conducted by researchers at the Karolinska Institute and other centers in Sweden compared twice-daily oral dimethyl fumarate (an immune-modulating therapy approved for multiple sclerosis) and intravenous rituximab (a cancer drug that depletes immune B cells, similar to ocrelizumab and ofatumumab) given every 6 months. Two hundred individuals with MS were randomly assigned to receive one of the two therapies, and were monitored for relapses, brain MRI-detected disease activity, and safety.
 
Results included:

• After two years, the group on rituximab experienced fewer relapses than the group on dimethyl fumarate (3% compared to 16%), and significantly more who were on rituximab were free of MRI-detected disease activity (79% compared to 63%).
• No differences in disease progression were observed.
• Some side effects occurred in both groups, including some serious adverse events expected for these therapies.

 
Comment: This study adds to previous studies suggesting that rituximab is an effective B-cell depleting therapy in MS. In an accompanying editorial, Drs. Robert Naismith and Ann Cross (Washington University) note that rituximab might be considered as a treatment option when and where FDA-approved B-cell depleting therapies are unavailable.  
 
“Safety and efficacy of rituximab versus dimethyl fumarate in patients with relapsing-remitting multiple sclerosis or clinically isolated syndrome in Sweden: a rater-blinded, phase 3, randomised controlled trial,” by Anders Svenningsson, Thomas Frisell, Joachim Burman, Jonatan Salzer, Katharina Fink, Susanna Hallberg, Joakim Hambraeus, Markus Axelsson, Faiez Al Nimer, Peter Sundström, Martin Gunnarsson, Rune Johansson, Johan Mellergård, Igal Rosenstein, Ahmad Ayad, Irina Sjöblom, Anette Risedal, Pierre de Flon, Eric Gilland, Jonas Lindeberg, Fadi Shawket, Fredrik Piehl, and Jan Lycke, was published in Lancet Neurology (Volume 21, Issue 8, P693-703, August 1, 2022).