Rituximab for the treatment of multiple sclerosis: a review.
Rituximab for the treatment of multiple sclerosis: a review.
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DOI：
10.1007/s00415-020-10362-z
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发表时间：
2022-01
影响因子：
6
通讯作者：
Patti F
中科院分区：
文献类型：
--
作者：
Chisari CG;Sgarlata E;Arena S;Toscano S;Luca M;Patti F
在过去的几十年里，越来越多的证据表明B细胞直接或间接参与多发性硬化（MS）的发病机制。来自几项研究的关于B细胞消耗疗法的功效和安全性的数据量的增加已经表明将这些药物作为治疗选择添加到用于MS的疾病修饰疗法（DMT）的当前设备中。特别地，利妥昔单抗（RTX），一种针对导致细胞介导的凋亡的CD 20阳性B淋巴细胞的嵌合单克隆抗体，已经被证明降低炎症活性，复发缓解型MS（RRMS）患者的复发率和磁共振成像（MRI）显示的新脑病变。其他证据也表明，进展性MS（PMS）患者可能受益于RTX，RTX也显示出良好的耐受性，具有可接受的安全性风险和有利的成本效益特征。尽管有这些令人鼓舞的结果，RTX目前被批准用于非霍奇金淋巴瘤，慢性淋巴细胞白血病，几种形式的血管炎和类风湿性关节炎，而它只能用于MS治疗。在北方欧洲国家之间，对于使用未经许可的药物治疗MS存在不同的规则。瑞典MS注册报告称，与其他每年开始的DMT治疗MS患者相比，标签外RTX处方率较高（53.5%），而丹麦和挪威神经科医生在大多数情况下不得不使用其他抗CD 20药物，如ocrelizumab。在本文中，我们回顾了RTX治疗MS的药代动力学，药效学，临床疗效，安全性和成本效益方面。特别是，随着新的抗CD 20 DMT的批准，最近全球范围内的COVID-19紧急情况以及此类药物感染风险可能增加，该综述揭示了RTX作为MS管理的替代治疗选择的使用，同时评论了关于这种药物的知识空白。
In the last decades, evidence suggesting the direct or indirect involvement of B cells on multiple sclerosis (MS) pathogenesis has accumulated. The increased amount of data on the efficacy and safety of B-cell-depleting therapies from several studies has suggested the addition of these drugs as treatment options to the current armamentarium of disease modifying therapies (DMTs) for MS. Particularly, rituximab (RTX), a chimeric monoclonal antibody directed at CD20 positive B lymphocytes resulting in cell-mediated apoptosis, has been demonstrated to reduce inflammatory activity, incidence of relapses and new brain lesions on magnetic resonance imaging (MRI) in patients with relapsing–remitting MS (RRMS). Additional evidence also demonstrated that patients with progressive MS (PMS) may benefit from RTX, which also showed to be well tolerated, with acceptable safety risks and favorable cost-effectiveness profile. Despite these encouraging results, RTX is currently approved for non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, several forms of vasculitis and rheumatoid arthritis, while it can only be administered off-label for MS treatment. Between Northern European countries exist different rules for using not licensed drug for treating MS. The Sweden MS register reports a high rate (53.5%) of off-label RTX prescriptions in relation to other annually started DMTs to treat MS patients, while Danish and Norwegian neurologists have to use other anti-CD20 drugs, as ocrelizumab, in most of the cases. In this paper, we review the pharmacokinetics, pharmacodynamics, clinical efficacy, safety profile and cost effectiveness aspects of RTX for the treatment of MS. Particularly, with the approval of new anti-CD20 DMTs, the recent worldwide COVID-19 emergency and the possible increased risk of infection with this class of drugs, this review sheds light on the use of RTX as an alternative treatment option for MS management, while commenting the gaps of knowledge regarding this drug.
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影响因子：
11.1
作者：
Baker D;Marta M;Pryce G;Giovannoni G;Schmierer K
通讯作者：
Schmierer K
影响因子：
13.8
作者：
Barmettler, Sara;Ong, Mei-Sing;Walter, Jolan
通讯作者：
Walter, Jolan
影响因子：
20.3
作者：
Carson, Kenneth R.;Evens, Andrew M.;Bennett, Charles L.
通讯作者：
Bennett, Charles L.
DOI：
10.1177/1352458514560923
发表时间：
2015-08
期刊：
Multiple sclerosis (Houndmills, Basingstoke, England)
影响因子：
--
作者：
Aung LL;Balashov KE
通讯作者：
Balashov KE
影响因子：
--
作者：
Chen KL;Chen J;Rao HL;Guo Y;Huang HQ;Zhang L;Shao JY;Lin TY;Jiang WQ;Zou DH;Hu LY;Wirian ML;Cai QQ
通讯作者：
Cai QQ