Hauser S SL, Waubant W. Arnold DL, Vollmer T, et al for HERMES Trial Group. B Cell Depletion with rituximab in relapsing remitting multiple sclerosis. NEJM 2008; 358: 676-678
and editorial
McFarland HF. Focus on research: the B Cell -- old player, new position on the team. NEJM 2008; 358: 664-666.
The phase 2 trial of Rituxan (Rituximab, Biogen Idex and Genentech) in relapsing remitting multiple sclerosis showed a significant reduction of relapses and of MRI lesions, the primary outcome measure. It was a short trial (48 weeks) and not powered to show an effect on disability. There was a rapid reduction not only of contrast enhancing lesions on MRI but also total lesions, within 4 weeks. McFarland opines that the benefits of led to increased interest in the role of B cells in diseases thought to be mediated by T cells. Some patients may have antibody mediated complement destructive lesions and in others B cells may precede lesion development. However the rapidity of the response suggests another mechanism. Possibly, B cells are involved in antigen presentation to T cells and activation of T cell programming (cites Rock, 1984). They may contribute to T cell priming and lesion formation. Treated patients showed the subsequent development of naive rather than memory B cells.
Many trials have shown a reduction of MRI lesions but not clinical disease activity. Since antibodies maybe involved in repair mechanisms, clinical status of the patients will need to be closely monitored in the phase 3 trial. B cells may alos be important within lesions, as CXCL13 which regulated B cell migration in lymphoid tissue is found within plaques.
The study is a phase 2 trial, which means that unanswered questions include low frequency side effects, duration of oeffect, and effect on disability. The study involves only 104 patients.
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Carnival of MS Bloggers and the launch of a unique and inclusive Global Multiple Sclerosis Community
Hi,
I came across your blog via the Carnival Of MS Bloggers, I am Squiffy of Squiffy's House of Fun, on the list ;O)
You may be interested to hear about a new, unique and inclusive Global Multiple Sclerosis Community providing not only up to date MS News and Stories, but a place where those affected by Multiple Sclerosis can communicate with others affected by the disease, and the wider public, by means of Online Blogs, Discussion Forums and Net-based social interaction, which the Multiple Sclerosis Resource Centre launched onth March 6th in collaboration with cre8Buzz.
Why not come and have a look, there are already some established MS bloggers signed up, and maybe join in, it is a great way to promote your blogs etc.
http://www.cre8buzz.com/multiple_sclerosis
squiffs ;O)
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