"Inexpensive" B cell depletion. Low dose IT rituxan...
More detail and graphs at link.Rapid depletion of B lymphocytes by ultra-low-dose rituximab delivered intrathecally
Objective: We are conducting an open-label phase 1b study on the efficacy of intrathecal (IT) administration of rituximab, provided via an Ommaya reservoir, for the treatment of progressive multiple sclerosis (PMS). The objective of this initial study was to monitor B lymphocytes in peripheral blood (PB) and CSF from the first 10 patients 1 year posttreatment.
Methods: Dose titration was performed with daily escalation from 1 mg to 25 mg IT rituximab (n 5 3). Lymphocyte subpopulations were monitored daily during dose escalation in PB by flow cytometry and subsequently every 3 months for 1 year, after a total dose of 3 3 25 mg. PB B-lymphocyte subpopulations for the remaining patients (n 5 7) were monitored at regular intervals. CSF lymphocyte subpopulations for all patients were monitored by flow cytometry every 2–3 months.
Results: The PB B-lymphocyte count dropped rapidly after the first 2 injections (total dose of 3.5 mg IT rituximab) to undetectable levels. Three 25-mg doses given once per week depleted peripheral B lymphocytes entirely for the following 3–6 month period.
Conclusions: Monoclonal antibodies seem to rapidly redistribute to the peripheral compartment following IT injection. Ultra-low doses of rituximab given IT are sufficient to cause complete depletion of peripheral B lymphocytes, indicating that low-dose IT treatment has the potential to be effective in both the CNS and systemic compartments.
Classification of evidence: This study provides Class IV evidence that for patients with PMS, rituximab provided via an Ommaya reservoir depletes peripheral blood B lymphocytes. Neurol Neuroimmunol Neuroinflamm 2015;2:e79; doi: 10.1212/NXI.0000000000000079
This would cost astronomically less than the traditional rituxan protocol...and no hours on end sitting in the infusion center. I would think this would open doors for a lot of people. I also think if I ever give rituxan another go, I'll save my $$ by going this route (last time did IT and IV). The LPs really aren't that bad...especially if you are saving $23000!