Rituximab is a WHO MS essessential medicine yet it is not approved for use in MS and not re-imbursed by NHS England. There are three approved anti-CD20 with rituximab most similar to ocrelizumab in terms of dosing and its structure. It is given at doses to kill B cells just like all the other anti-CD20 and sure enough it works. With all the mess going on in the middle East lets hopes supply for peoples medicines do not get cut. It is interesting that Iran makes most MS drugs…they don’t care about patents…after all what are fines going to mean to them after years of isolation.
Ismail G, Zeineddine M, Al-Roughani R, Ahmed SF, Al-Mahdawi A, Khoury S, El-Ayoubi N, Inshasi J, Al-Khabouri J, Al-Asmi A, Gouider R, Aljarallah S, Alkhawajah N, Al Malik Y, Abulaban A, Makkawi S, Khojah O, El-Hajj T, Massouh J, AlSalamat H, Al-Hajje A, Salameh P, Boumediene F, Yamout B. The real-world effectiveness and safety of off-label rituximab in a large cohort of Middle Eastern multiple sclerosis patients. Neurotherapeutics. 2026; 23:e00861
Rituximab (RTX) is increasingly used off-label for the treatment of multiple sclerosis (MS), yet real-world evidence from Middle Eastern populations remains limited. This multicenter, retrospective observational study evaluated the effectiveness and safety of RTX using data from the MENACTRIMS registry across seven Middle Eastern countries (Iraq, Kuwait, Lebanon, Oman, Saudi Arabia, Tunisia, and the United Arab Emirates). A total of 774 MS patients were included: 482 with relapsing-remitting MS (RRMS) and 292 with active secondary progressive MS (aSPMS). Patients received intravenous RTX at doses of 500 mg or 1000 mg every 6-12 months. The cohort was predominantly female (72.1%), with a mean age of 39.6 years and a mean disease duration of 11.9 years from symptom onset. RTX treatment was associated with a significant reduction in annualized relapse rate (ARR), decreasing from 1.65 to 0.08 in RRMS and from 2.03 to 0.02 in aSPMS (p < 0.001). Expanded Disability Status Scale (EDSS) scores remained stable in RRMS but increased by 1.0 point in aSPMS (p < 0.001). MRI activity was suppressed in most RRMS patients, with 89.1% showing no new or enlarging lesions, whereas only 8.1% of aSPMS patients demonstrated similar stability. NEDA-3 was achieved in 47.3% of RRMS patients. A total of 491 adverse events were reported, predominantly mild infusion-related reactions (92.5%). Overall, off-label RTX demonstrated substantial real-world effectiveness and a favorable safety profile in Middle Eastern MS patients, particularly in RRMS.
Source: multiple-sclerosis-research.org