Although T cells are generally considered to have prime importance in the pathogenesis of MS, there is no doubt that B cells and their antibody products are also important. Therefore, the inhibition of autoreactive B cells is a logical therapeutic aim. Rituximab is a mouse-human chimeric mAb against CD20, a differentiation antigen that is expressed on B cells. Rituximab is administered intravenously every 6-12 months. In a pilot study, rituximab showed promising results in patients with MS or neuromyelitis optica, and is currently being further evaluated in pilot studies with neuromyelitis patients (Cree et al. 2005) and non-respond-ers to mitoxantrone (Stuve et al. 2005).
A large, 1-year phase II trial in relapsing remitting MS will test the safety and preliminary efficacy of one round of injections of the drug versus placebo in 180 patients (a list of currently planned trials can be found on the website of the National MS Society USA at www.nationalmssociety.org/research.asp). Another phase II/III study will evaluate the efficacy of rituximab in patients with primary progressive MS over 2 years (www.nationalmssociety.org/research.asp).
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