.Norway study of Rituximab

[Sue Klaus]

1. What blood test can be given to determine whether an MECFS patient has the proliferative B cells in their bloodstream, that rituximab and other drugs would eliminate from the bloodstream?
2. Would it be helpful at all after receiving this kind of treatment to also have one or two sessions of dialysis, to clear out the detritus from the bloodstream that is left behind after the rituximab treatment?
3. Is one of the reasons that this is possibly going to be helpful that clearing these proliferative b-cells would allow more space in the bloodstream for more red blood cells to be circulating, thus providing more oxygen to cells?

 

[Trish]

I'm hoping we'll get the answers to a lot of our questions when the Phase 3 trial results are published next year.

I'm not an expert on any of this, but here's my take on a couple of your questions:

2. Dialysis is used when the kidneys aren't functioning properly. I don't think there's any evidence that this is the case in ME.

3. I doubt there's a problem with space in the bloodstream for other kinds of cells. I think it's more about getting rid of B cells that are doing the wrong thing in immunological terms - maybe producing autoimmune antibodies which hopefully the new generation B cells will not do.

 

[Rain]

I do actually think they tried out dialysis in a few patients during the early stages of Rituximab trials. Seems like they quickly stepped away from it as it’s years ago and it has not been mentioned since.

 

[Adrian]

2. Dialysis is used when the kidneys aren't functioning properly. I don't think there's any evidence that this is the case in ME.

I think there was a German team looking at antibodies who were doing a trial with some sort of blood filtering to try to remove anti-bodies. It should work more quickly than Rituximab but for a much shorter time. I think there was talk about doing that along with Rituximab so that any antibodies are cleared out by the filtering and then Rituximab kills of the b-cells stopping more anti-bodies being created.

3. Is one of the reasons that this is possibly going to be helpful that clearing these proliferative b-cells would allow more space in the bloodstream for more red blood cells to be circulating, thus providing more oxygen to cells?

The theories are around getting rid of antibodies that are causing some harm - probably through some sort of signalling rather than just reducing b-cells. B-cells cause/control the production of antibodies. The delay in the action of Rituximab seems to support this theory.

 

[Gingergrrl]

@Sue Klaus

1) My understanding (which could be totally wrong!) is that it is not proliferative B cells, or an abnormal number of B cells, vs. B cells creating pathogenic auto-antibodies and Ritux stops the auto-abs at production level.

2) I don't think dialysis would be diagnostically helpful vs. something like plasmapheresis or immunoadsorption might. In my case, having high dose IVIG first was diagnostically helpful.

3) No idea re: the oxygen question!