Efficacy of rituximab in secondary progressive multiple sclerosis: Insights from magnetic resonance imaging and disability assessments

Background: Although there are a few options for the treatment of patients with secondary progressive multiple sclerosis (SPMS), rituximab (RTX) is used as an off-label treatment. This study aimed to investigate the efficacy of RTX on disability status and volumetric magnetic resonance imaging (MRI)...

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Main Authors: Fereshteh Ashtari, Yousef Mokary, Iman Adibi, Vahid Shaygannejad, Neda Ramezani, Fariba Davanian, Maryam Ahmadi
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-07-01
Series:Journal of Research in Medical Sciences
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Online Access:https://journals.lww.com/10.4103/jrms.jrms_690_24
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Summary:Background: Although there are a few options for the treatment of patients with secondary progressive multiple sclerosis (SPMS), rituximab (RTX) is used as an off-label treatment. This study aimed to investigate the efficacy of RTX on disability status and volumetric magnetic resonance imaging (MRI) findings in SPMS. Materials and Methods: This study was conducted on 31 patients with SPMS treated with RTX 1000 mg intravenously every 6 months. Expanded Disability Status Scale (EDSS), 25-Foot Walk Test (25-FWT), 9-Hole Peg Test (9-HPT), and brain MRI were performed at the baseline and after 12 months. Results: No significant changes were observed in EDSS, timed 25-FWT, and 9-HPT within 12 months of RTX treatment (P > 0.05). There was a decrease in 9-HPT time in both the right and left hands, but it was not significant. During the 12-month assessment, white matter (WM) and gray matter volumes decreased by −41.48 ± 2.36 and −31.65 ± 8.84, respectively. However, these differences were not statistically significant (P > 0.05). The only significant change was an increase in the volume of deep WM lesions (WMLs) (0.26 ± 0.19 vs. 0.38 ± 0.29, P = 0.024). A significant association was found between the EDSS at the 12th month and baseline deep WML volume (r = 0.383, P = 0.044). Conclusion: Our results showed that the level of disability based on EDSS, timed 25-FWT, and 9-HPT did not increase significantly during 12 months of treatment with RTX. These findings suggest that RTX may play a role in disease stabilization and preventing disability progression, especially in the upper limbs. Further studies with larger sample sizes are necessary to confirm this finding.
ISSN:1735-1995
1735-7136