B-Lymphocyte Depletion in Patients With ME/cfs: A Randomized, Double-Blind, Placebo-Controlled Trial (2019) Fluge et al

The idea of infection inducing autoimmunity is very old and in the great majority of diseases wrong. In the few situations where the immune system caues harm after infection the immune reactions tends to be short lived, leaving damage but not continuing (rheumatic fever and guillain-barre). Nodding disease might fit and also narcolepsy.

Ritiximab would not touch rheumatic fever.

I am not overenthusiastic abkout these high tech trawling for antigen studies but they might tirn something up. People have looked before (in the UK) andnot found anything.
 
Milo said:
Rituximab is not a treatment of “all” autoimmune diseases...
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I've struggled to understand this for some time i.e. rituximab kills B-cells and B-cells produce antibodies. On the face of it, if you have a B-cell autoimmune (auto-antibodies) disease then rituximab would successfully treat this.
Are there other cells (not B-cells) which produce antibodies (and therefore potentially auto-antibodies) and if so could you provide details?
Is rituximab only effective against some B-cells i.e. there are other B-cells which produce antibodies and if so could you provide details?

T-cell autoimmunity has been discounted; Ron Davis speaking at the emerge conference last month.

Thanks

@Jonathan Edwards
 
I would not discount T cells. All we know is that one preliminary finding from Mark Davis did not hold up. T cells cause post infective illnesses of pther sorts.

There is a reason why rituximab does not work for all autoantibody based illnesses. Antibodies are actually made by daughters of B cells called plasma cells. Plasma cells can live for decades and rituximab cannot touch them. The lucky thing about sevdral autoimmune disease is that the relevant plasma cells only live about 3-6 months. They probably stay in spleen rather than getting dug in to bone marrow. So continued autoantibody produ tion needs replenish.ent from B cells. So killing B cells with ritux blcks the supply of new antibodies.
 
hinterland said:
Does anyone know if patients in the placebo group got active premedication before their main course of ‘Rituximab’, or were all their meds fakes? Isn’t Ritux usually served following a starter of glucocorticoids, and possibly some other stuff? These might be a possible cause of adverse reaction, in some cases.
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Someone I know who had Ritux (not for ME) was given an anti histamine first but she had adverse reactions to other things so it wasn't necessarily routine.

I wonder if the adverse reactions were just related to the additional exertion of getting to a clinic and having treatment. If a patient is already severe this could cause a relapse.

Adam pwme said:
Does the 18.9% serious adverse events in the placebo group suggest that adverse events in PACE were not properly recorded?
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If I remember correctly PACE reported two things I can't remember what they called them but they had recorded events and then a committee filtered them to see if they could be treatment related.

.
 
Dagens Medisin has an article today about RituxME and has interviewed Øystein Fluge.

Dagens Medisin: Norsk studie: Legemiddel hadde ikke effekt på ME
google translation: Norwegian study: Medication had no effect on ME

Fluge says the results of the study show how important it is to do double-blind and randomized placebo-controlled studies.

- The purpose of the study was to either strengthen or weaken the hypothesis that B cells were important for the symptom maintenance of ME.

- When the result is negative, it is good that it is unambiguous and clear. We should be happy about that. The purpose is not to go for one or the other - but to know what is actually true, says Fluge.

- It is so that some patients say that they have experienced the effect of this medicine. Of course, for a single patient it is difficult to know what has caused improvement - but at group level we can safely say that rituximab has no effect.
 
Has anyone been able to access the full paper? I’ve still not managed to get it to come up on Scihub, though I’ve been having Scihub issues lately.
 
Simone said:
Has anyone been able to access the full paper? I’ve still not managed to get it to come up on Scihub, though I’ve been having Scihub issues lately.
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Oh, you can't access it now either? Was just linking to a table in another thread, not realising it might not be accessible to all.

I can read it now, not sure why.
 
There is something odd about access to this. I cannot get it through my college account. I would have to use something called Athens that I do not have a registration for.
 
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