Reduced inflammation in relapsing-remitting multiple sclerosis after therapy switch to rituximab

Neurology. 2016 Jul 12;87(2):141-7. doi: 10.1212/WNL.0000000000002832. Epub 2016 Jun 17.


Objective: To describe the effects of switching treatment from ongoing first-line injectable therapies to rituximab on inflammatory activity measured by MRI and levels of CSF neurofilament light chain (CSF-NFL) in a cohort of patients with clinically stable relapsing-remitting multiple sclerosis (RRMS).

Method: Seventy-five patients with clinically stable RRMS treated with the first-line injectables interferon-β (IFN-β) and glatiramer acetate (GA) at 3 Swedish centers were switched to rituximab in this open-label phase II multicenter study. After a run-in period of 3 months, 2 IV doses of 1,000 mg rituximab were given 2 weeks apart followed by repeated clinical assessment, MRI, and CSF-NFL for 24 months.

Results: The mean cumulated number of gadolinium-enhancing lesions per patient at months 3 and 6 after treatment shift to rituximab was reduced compared to the run-in period (0.028 vs 0.36, p = 0.029). During the first year after treatment shift, the mean number of new or enlarged T2 lesions per patient was reduced (0.01 vs 0.28, p = 0.004) and mean CSF-NFL levels were reduced by 21% (p = 0.01).

Conclusions: For patients with RRMS, a treatment switch from IFN or GA to rituximab is associated with reduced inflammatory activity measured by MRI and CSF-NFL.

Classification of evidence: This study provides Class IV evidence that rituximab has an equal or superior effect in reducing inflammatory activity in RRMS measured by MRI and CSF-NFL compared to first-line injectables during the first year after treatment shift.

Publication types

  • Clinical Trial, Phase II
  • Multicenter Study

MeSH terms

  • Adult
  • Biomarkers / cerebrospinal fluid
  • Contrast Media
  • Disability Evaluation
  • Drug Substitution*
  • Female
  • Follow-Up Studies
  • Gadolinium
  • Glatiramer Acetate / administration & dosage
  • Humans
  • Immunologic Factors / administration & dosage*
  • Interferon-beta / administration & dosage
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multiple Sclerosis, Relapsing-Remitting / cerebrospinal fluid
  • Multiple Sclerosis, Relapsing-Remitting / diagnostic imaging
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy*
  • Neurofilament Proteins / cerebrospinal fluid
  • Rituximab / administration & dosage*
  • Sweden
  • Treatment Outcome
  • Young Adult


  • Biomarkers
  • Contrast Media
  • Immunologic Factors
  • Neurofilament Proteins
  • neurofilament protein L
  • Rituximab
  • Glatiramer Acetate
  • Interferon-beta
  • Gadolinium