Question about Rituxan

Q: My wife is a 54 year old newly diagnosed Caucasian female with RRMS. She has had a 25 year history of intermittent trigeminal nerve neuralgia. She is healthy otherwise with no disability, per se, from her MS. Her JCV titers were 3.22 in October and 3.55 in November, 2014. We are considering Rituxan treatment through a Kaiser Permanente study. Any thoughts on PML risk in Rituxan therapy in an immunosuppressed naïve patient with high JCV titers?

A: Rituximab is a great treatment for relapsing forms of MS and I would encourage you to consider the Kaiser study if you believe this is the best option for you and your wife; I am not aware of other treatments she has tried in the past or the details of her case, so I can not state whether I consider this the most appropriate treatment choice. I can tell you that there is no known relationship between JC virus antibody index levels and risk of PML on rituximab therapy. It is generally felt that the risk of PML on Rituximab therapy is very low (< 1/25,000).  You do mention that she is immunosuppressed but naive to treatment; what exactly do you mean? Does she have a condition that suppresses her immune system or did she receive previous treatments with chemotherapy? These are the only things that would suppress her immune system. Good luck.

Revere (Rip) Kinkel MD
Director of the UCSD Multiple Sclerosis Center

PLEASE NOTE:  The information/opinions on this site should be used as an information resource only.  This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.