Low-Dose Rituximab Regimen Claims Superiority Over Conventional Treatment in CIDP

Newly published in Annals of Clinical and Translational Neurology, results from a retrospective cohort study in China showed that the simplified regimen of combined low-dose rituximab (Rituxan; Genentech/Biogen) displayed superior efficacy and safety over conventional therapy for the treatment of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).¹

Among 73 Chinese patients diagnosed with CIDP according to EAN/PNS criteria guidelines², 40 of the participants represented the conventional first-line therapy cohort and 33 of them were assigned in the combined low-dose rituximab (100 mg per infusion) cohort. Patients in the combined rituximab cohort had similar baseline scores with the control cohort across most outcome measures but higher Total Symptoms Score (TSS) scores for severity. Over 52 weeks, participants in the low-dose rituximab group showed greater improvements in Inflammatory Rasch‐built Overall Disability Scale (I‐RODS) centile scores at each of 4 visits, achieving the study's primary efficacy outcome.

“In comparison with conventional therapy for CIDP, the better improvements and outcomes were quickly obtained by induction and maintenance treatment with combined low‐dose rituximab, thereby significantly reducing corticosteroids dosage and deterioration occurrence during the follow‐up,” Led by Wei Zhang, MD, professor in the department of neurology, Tangdu Hospital, Fourth Military Medical University in China, and colleagues wrote.¹ “The combination of low‐dose rituximab therapy presented the similarly favorable efficacy in both typical CIDP and CIDP variants. Early initiating combined low‐dose rituximab treatment showed better improvements of CIDP in a short‐term than delayed initiation, while had no influence on the long‐term favorable prognosis of the regimen.”

Led by Wei Zhang, MD, professor in the department of neurology, Tangdu Hospital, Fourth Military Medical University in China, the study collected and analyzed data of patients with CIDP from 7 tertiary hospitals between March 2018 and March 2023. The primary efficacy outcome was the significant improvements of I‐RODS scores observed at baseline and 4 regular visits (4, 16, 28, and 52 weeks) in combined rituximab cohort compared with control cohort with conventional therapy. The secondary outcome measures were improvements in modified Rankin Scale (mRS), Inflammatory Neuropathy Cause and Treatment (INCAT), Overall Neuropathy Limitation Scale (ONLS), TSS, and Composite Autonomic Symptom Score (COMPASS 31) scores at each visit compared with the control cohort, as well as significantly reduced corticosteroids dosage and deterioration occurrence during the follow‐up.

READ MORE: Long-Term Disability of Chronic Demyelinating Polyradiculoneuropathy Lessened With Early Treatment Initiation

At 16 weeks, similar improvements were observed in mRS, INCAT, and ONLS scores for the rituximab group, with continuous gains in COMPASS 31 and TSS scores, indicating that the secondary outcomes were achieved in the study. The combined rituximab cohort also had higher rates of favorable responses and nondeterioration in I-RODS and other scales, along with significantly lower corticosteroid use during follow-up. Authors noted that these findings highlight the superior overall efficacy of low-dose rituximab for CIDP treatment.

In the conventional therapy cohort, outcomes did not differ by first-line drug or CIDP subtype. The combined rituximab cohort showed better results for both typical CIDP and variants, with no significant differences between subtypes, confirming the efficacy of low-dose rituximab for both. Early initiation of rituximab (less than 10 weeks) led to faster improvements within 28 weeks but had no impact on long-term outcomes at 52 weeks, suggesting early treatment benefits short-term recovery without affecting long-term prognosis.

Authors noted that in the cohort group treated with the combined low‐dose rituximab, 4 patients experienced infusion‐related symptoms, which were presented as skin rash or pruritus during the administration of the therapy. Despite this, the symptoms gradually resolved following oral cetirizine. In addition, authors reported no rituximab correlated serious adverse events occurred in the patients and that rituximab‐treated patients did not receive any premedication of steroids to avoid infusion reactions.

All told, the current study had several limitations such as it was a retrospective analysis without comparison to the natural course of CIDP or other dosing regimens, included a small sample size with limited follow-up, and relied on routine clinical data, which varied in quality. Irregular conventional treatments in both cohorts may have undervalued the control group’s therapeutic effect but did not affect rituximab efficacy evaluation. Despite these limitations, the findings on the efficacy and safety of low-dose rituximab may be promising, highlighting the need for larger prospective studies to validate these results.

REFERENCES
1. Du Y, Yan Q, Li C, et al. Efficacy and safety of combined low-dose rituximab regimen for chronic inflammatory demyelinating polyradiculoneuropathy. Ann Clin Transl Neurol. 2025;12(1):180-191. doi:10.1002/acn3.52270
2. Van den Bergh PYK, van Doorn PA, Hadden RDM, et al. European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force-Second revision. J Peripher Nerv Syst. 2021;26(3):242-268. doi:10.1111/jns.12455