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

Abstract

Background: Although there are a few options for the treatment of patients with econdary 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 travenously 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  ignificant (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.