Cyclophosphamide versus Rituximab in Progressive forms of Multiple Sclerosis, Flaws in Treatment with Rituximab

This study aimed to compare the efficacy of Rituximab versus Cyclophosphamide on active secondary progressive multiple sclerosis (SPMS).

The randomized clinical trial was performed from 2015 to 2017 in multiple sclerosis (MS) clinics affiliated to Isfahan MS society (IMSS). Patients were randomized to two groups and one of them received Rituximab that was repeated every six months in case of medical indication. The other one received monthly pulse of methylprednisolone plus cyclophosphamide (Endoxan, Baxter, UK) until two years. Expanded disabilities status scale (EDSS), clinical and MRI findings were assessed every six months. Statistical analysis was performed using SPSS software.

39 patients in the Rituximab group and 30 in the Cyclophosphamide group with similar age and gender distribution were entered for analysis. At baseline, the mean number of attacks in the Rituximab group was significantly more than the Cyclophosphamide group (P-value = 0.0001). After 6, 12, and 18 months of treatment, the rate of attacks was similar between groups although it increased significantly in the Rituximab group (P-value = 0.030) after 24 months of treatment. EDSS was increased in Rituximab group more than the other group at the end of the study. Both drugs were well-tolerated by patients.

The EDSS was increased in Rituximab group but the disability score did not worsen in the Cyclophosphamide group.  Both therapies were associated with reduction in disease attacks and improvement in radiologic findings in a two-year period of follow-up.