Rituximab Better than Fingolimod for Preventing Relapses in Multiple Sclerosis Patients

Preventing relapses for patients with highly active multiple sclerosis (MS) is more easily accomplished with rituximab than with fingolimod, according to findings published in the Annals of Neurology.

Researchers from the Karolinska Institute in Sweden observed 256 MS patients in order to compare outcomes for MS patients who switched from natalizumab due to JC virus infection with different preferential use of rituximab and fingolimod across three medical centers. There were 51 percent of patients in the Stockholm branch which preferred fingolimod, 88 percent in Gothenburg, and 19 percent in Umea.

The researchers noted that about half of the general population is infected with JC virus, which causes no problems under typical circumstances. JC virus is capable of causing progressive multifocal leukoencephalopathy (PML) in immunodeficient patients or those on immunosuppressant drugs. Natalizumab is among the most effective MS treatments but also carries an elevated risk of PML, the researchers added.

“Termination of natalizumab treatment has also been suggested to be associated with a risk of rebound disease activity, making it difficult to manage switches in clinical practice,” Dr. Fredrik Piehl, lead author of the study, explained in a press release.

About 2 percent of patients who switched to rituximab and about 17 percent of those patients who switched to fingolimod experienced an MS relapse within 1.5 years. The investigators added that rituximab depletes circulating B cells and fingolimod separates lymphocytes in lymph nodes. The difference between effectiveness of the drugs was not explained by the differences in the baseline characteristics of the patients in each group.

“Our findings suggest an improved effectiveness and tolerability of rituximab compared with fingolimod in stable MS patients who switch from natalizumab due to JC virus antibody positivity,” the study authors concluded. “Although residual confounding factors cannot be ruled out, the shared reason for switching from natalizumab and the preferential use of either rituximab or fingolimod in two of the centers mitigates these concerns.”