Hip
Senior Member
- Messages
- 17,874
The UK National Health Service (NHS) provide rituximab treatment for free for qualifying systemic lupus erythematosus patients. See: Lupus - Treatment - NHS Choices.
The NHS criteria for offering rituximab treatment to systemic lupus erythematosus patients is the following:
The reason rituximab is offered for free to systemic lupus erythematosus patients, but not to ME/CFS patients, is presumably because of the large number of studies and evidence base demonstrating the efficacy of rituximab for lupus.
The very first study I could find on the rituximab treatment of lupus was published in 2002, and immediately after that, there was an explosive growth across the world in the number of lupus rituximab studies being conducted.
PubMed lists a total of 150 lupus rituximab studies and papers that have been published from 2002 to present. And in the first decade from 2002 to 2012, there were around 100 lupus rituximab studies published.
I have listed a small selection of 37 lupus rituximab below, as a representative sample covering the decade from 2002 to 2012.
By contrast, to my knowledge, there have only been three studies published on the rituximab treatment of ME/CFS so far, with a fourth underway, all of which were conducted by Oystein Fluge and Olav Mella in Norway. These 4 ME/CFS studies are also listed below. When the fourth study is published, these 4 studies will also span a time period of around a decade.
But note the huge difference in the number of studies, and the lack of explosive growth or global interest in replicating the ME/CFS rituximab studies. In the case of lupus, there were around 100 lupus rituximab studies published globally in the first decade. But for a similar decade timespan, there have only been 4 ME/CFS rituximab studies, and all from the same country of Norway, by the same authors, with no replication studies in other countries.
Why is this? Why the explosive interest in the lupus rituximab studies, but so much less interest in the ME/CFS rituximab studies?
Are ME/CFS patients once again being seen as second class citizens, sent to the back of queue for research and treatment? Or are there legitimate reasons for this slow uptake and lack of funding for ME/CFS rituximab research?
The NHS criteria for offering rituximab treatment to systemic lupus erythematosus patients is the following:
Rituximab will only be funded for use in Systemic Lupus Erythematosus (SLE) where the following criteria are met:
1. Diagnosis of SLE (fulfilling either ACR or SLICC criteria) AND;
2. Active disease (defined as at least one BILAG A score and/or 2B scores, or a SLEDAI-2K score >6) AND;
3. Failure to respond or having adverse events to, two or more standard immunosuppressive therapies.
4. All patients who meet the above criteria of refractory disease activity sufficient to justify the use of rituximab, must be managed at, or in collaboration, with a centre commissioned to provide specialised services that has expertise in the assessment and management of SLE.
Source: here
The reason rituximab is offered for free to systemic lupus erythematosus patients, but not to ME/CFS patients, is presumably because of the large number of studies and evidence base demonstrating the efficacy of rituximab for lupus.
The very first study I could find on the rituximab treatment of lupus was published in 2002, and immediately after that, there was an explosive growth across the world in the number of lupus rituximab studies being conducted.
PubMed lists a total of 150 lupus rituximab studies and papers that have been published from 2002 to present. And in the first decade from 2002 to 2012, there were around 100 lupus rituximab studies published.
I have listed a small selection of 37 lupus rituximab below, as a representative sample covering the decade from 2002 to 2012.
By contrast, to my knowledge, there have only been three studies published on the rituximab treatment of ME/CFS so far, with a fourth underway, all of which were conducted by Oystein Fluge and Olav Mella in Norway. These 4 ME/CFS studies are also listed below. When the fourth study is published, these 4 studies will also span a time period of around a decade.
But note the huge difference in the number of studies, and the lack of explosive growth or global interest in replicating the ME/CFS rituximab studies. In the case of lupus, there were around 100 lupus rituximab studies published globally in the first decade. But for a similar decade timespan, there have only been 4 ME/CFS rituximab studies, and all from the same country of Norway, by the same authors, with no replication studies in other countries.
Why is this? Why the explosive interest in the lupus rituximab studies, but so much less interest in the ME/CFS rituximab studies?
Are ME/CFS patients once again being seen as second class citizens, sent to the back of queue for research and treatment? Or are there legitimate reasons for this slow uptake and lack of funding for ME/CFS rituximab research?
Studies on the Rituximab Treatment of Myalgic Encephalomyelitis
2009. Patients given RTX: 3. Funding: ? (Fluge and Mella, Norway)
Clinical impact of B-cell depletion with the anti-CD20 antibody rituximab in chronic fatigue syndrome: a preliminary case series
2011. Patients given RTX: 15. Funding: ? (Fluge and Mella, Norway)
Benefit from B-lymphocyte depletion using the anti-CD20 antibody rituximab in chronic fatigue syndrome. A double-blind and placebo-controlled study
2015. Patients given RTX: 29. Funding: ? (Fluge and Mella, Norway. Phase II study)
B-Lymphocyte Depletion in Myalgic Encephalopathy/ Chronic Fatigue Syndrome. An Open-Label Phase II Study with Rituximab Maintenance Treatment
2018. This is when the Fluge and Mella Phase III study results will be published.
Studies on the Rituximab Treatment of Systemic Lupus Erythematosus
2002. Patients given RTX: 6. Funding: ? (A Jonathan Edwards, Geraldine Cambridge et al study)
An open study of B lymphocyte depletion in systemic lupus erythematosus
2003. Patients given RTX: 12. Funding: Genentech biotechnology and IDEC Pharmaceuticals
The relationship of FcγRIIIa genotype to degree of B cell depletion by rituximab in the treatment of systemic lupus erythematosus
2003. Patients given RTX: 2. Funding: ? (German study)
Successful long-term treatment of systemic lupus erythematosus with rituximab maintenance therapy
2004. Patients given RTX: 5. Funding: ? (Japanese study)
Down-regulation of CD40 and CD80 on B cells in patients with life-threatening systemic lupus erythematosus after successful treatment with rituximab
2004. Patients given RTX: 18. Funding: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH); Lupus Foundation of America; National Institute of Allergy and Infectious Diseases (NIH).
Rituximab improves peripheral B cell abnormalities in human systemic lupus erythematosus
2005. Patients given RTX: 24. Funding: ? (A Jonathan Edwards, Geraldine Cambridge et al study)
B-cell depletion in the treatment of patients with systemic lupus erythematosus: a longitudinal analysis of 24 patients
2005. Patients given RTX: 1. Funding: ?
Rituximab in childhood systemic lupus erythematosus refractory to conventional immunosuppression | SpringerLink
2005. Review paper. Funding: ?
Rituximab anti-B-cell therapy in systemic lupus erythematosus: pointing to the future
2005. Patients given RTX: 7. Funding: ? (UK study)
B lymphocyte depletion therapy in children with refractory systemic lupus erythematosus
2006. Patients given RTX: 1. Funding: ?
Rituximab use in systemic lupus erythematosus pneumonitis and a review of current reports
2006. Patients given RTX: 11. Funding: Association française Pour Le Syndrome d’Evans
Rituximab therapy for childhood-onset systemic lupus erythematosus
2006. Patients given RTX: 11. Funding: Roche (UK); Wellcome Research Leave Award for Clinical Academics; Medical Research Council.
Long-term comparison of rituximab treatment for refractory systemic lupus erythematosus and vasculitis: Remission, relapse, and re-treatment
2006. Patients given RTX: 10. Funding: ? (Japanese study)
Efficacy of rituximab (anti-CD20) for refractory systemic lupus erythematosus involving the central nervous system
2006. Patients given RTX: 32. Funding: ? (A Jonathan Edwards, Geraldine Cambridge et al study)
B cell depletion therapy in systemic lupus erythematosus: long-term follow-up and predictors of response
2006. Patients given RTX: 16. Funding: ? (A Jonathan Edwards, Geraldine Cambridge et al study)
B cell depletion therapy in systemic lupus erythematosus: Effect on autoantibody and antimicrobial antibody profiles
2006. Patients given RTX: 10. Funding: Swedish Medical Research Council, Professor Nanna Svartz Research Foundation, King Gustaf V's 80-year Foundation, Börje Dahlin Foundation, Signe and Reinhold Sunds Foundation for Rheumatological Research, Karolinska Institutet Foundations, and an unrestricted grant from Roche Sweden.
Differential effects on BAFF and APRIL levels in rituximab-treated patients with systemic lupus erythematosus and rheumatoid arthritis
2007. Patients given RTX: 15. Funding: ? (Japanese study)
A multicenter phase I/II trial of rituximab for refractory systemic lupus erythematosus
2007. Patients given RTX: 15. Funding: NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases), Lupus Foundation of America, Alliance for Lupus Research, Lupus Clinical Research Consortium, NIH (National Institute of Allergy and Infectious Disease), U19-Rochester Autoimmunity Center of Excellence.
Delayed memory B cell recovery in peripheral blood and lymphoid tissue in systemic lupus erythematosus after B cell depletion therapy
2007. Patients given RTX: 18. Funding: Florida’s Department of Health, Children’s Medical Services.
Rituximab therapy for juvenile-onset systemic lupus erythematosus
2008. Patients given RTX: 1. Funding: ? (Lebanese study)
Successful Treatment of Refractory Skin Manifestations of Systemic Lupus Erythematosus with Rituximab: Report of a Case
2008. Patients given RTX: 3. Funding: ? (Japanese study)
A dose-escalation study of rituximab for treatment of systemic lupus erythematosus and Evans’ syndrome: immunological analysis of B cells, T cells and cytokines
2008. Patients given RTX: 1. Funding: ? (US study)
Rituximab treatment of pulmonary arterial hypertension associated with systemic lupus erythematosus: a case report
2009. Patients given RTX: 9. Funding: ?
B-Cell Depletion for Autoimmune Thrombocytopenia and Autoimmune Hemolytic Anemia in Pediatric Systemic Lupus Erythematosus
2009. REview paper. Funding: ? (Mexican paper)
Use of rituximab in patients with systemic lupus erythematosus: An update
2009. Patients given RTX: 45. Funding: ? (A Jonathan Edwards, Geraldine Cambridge et al study)
A retrospective seven-year analysis of the use of B cell depletion therapy in systemic lupus erythematosus at university college london hospital: The first fifty patients
2009. Patients given RTX: 1. Funding: ? (UK study)
Bilateral retinal vasculitis in a patient with systemic lupus erythematosus and its remission with rituximab therapy
2009. Patients given RTX: 169. Funding: Genentech biotechnology.
Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: The randomized, double-blind, phase ii/iii systemic lupus erythematosus evaluation of rituximab trial
2009. Patients given RTX: 52. Funding: / (Mexican study)
Anti-CD20 therapy in patients with refractory systemic lupus erythematosus: a longitudinal analysis of 52 Hispanic patients
2010. Patients given RTX: 10. Funding: ? (Singaporean Study)
Use of rituximab in the treatment of refractory systemic lupus erythematosus: Singapore experience
2010. Patients given RTX: 31. Funding: ?
Long-term efficacy and safety of rituximab in refractory and relapsing systemic lupus erythematosus
2010. Patients given RTX: 10. Funding: Ministry of Health, Labor and Welfare of Japan, the Ministry of Education, Culture, Sports, Science and Technology of Japan, and the University of Occupational and Environmental Health, Japan.
Phenotypic Changes of Lymphocytes in Patients with Systemic Lupus Erythematosus Who Are in Longterm Remission After B Cell Depletion Therapy with Rituximab
2011. Patients given RTX: 10. Funding: ? (Chinese study)
Low-dose rituximab therapy for refractory thrombocytopenia in patients with systemic lupus erythematosus—a prospective pilot study
2011. Patients given RTX: 42. Funding: ? (Columbian study)
Rituximab induces a rapid and sustained remission in Colombian patients with severe and refractory systemic lupus erythematosus
2011. Patients given RTX: 39. Funding: National Institute for Health Research (NIHR) Research Training Fellowship; NIHR Clinician Scientist Award
B cell biomarkers of rituximab responses in systemic lupus erythematosus
2012. Review paper. Funding: ? (Chinese study)
Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis
2012. Patients given RTX: 8. Funding: ? (UK study)
Early treatment with rituximab in newly diagnosed systemic lupus erythematosus patients: a steroid-sparing regimen
There are around 150 studies on PubMed on the rituximab treatment of systemic lupus erythematosus and its complications and comorbidities. The above 37 papers are just a small sample of this total of 150 studies.
Last edited: