How long until there are improvements?

It’s been six weeks now since I’ve completed my last Rituxan treatment. I have not noticed any change yet except the numbness in my tongue seems to be less concentrated in one place, more diffuse, not as severe. But I don’t expect any improvement for quite some time. Even if the Rituxan successfully eliminated the aberrant B-cell producing damaging antibodies, there still could be anywhere between 20 and 40% of the original anti-MAG antibodies in circulation attacking the myelin. We just have to be patient.

Considering different people may react differently, here are excerpts from two case studies with opposite outcomes. The first one a 72 year old man:

[QUOTE]Treated with rituximab (375 mg/m2 for 4 weeks), the patient presented at follow-up (3, 6, 8 and 11 months later) a progressive improvement, more evident starting from 6 months after therapy. Eventually, he was able to walk unassisted for a short distance. He regained full functionality at upper limbs and was able to perform his daily activities (shaving, washing, eating) independently. The IgM/k protein significantly decreased (total IgM 1.3 g/l). Electrophysiological studies improved, but only 8 months after therapy mild signs of reinnervation appeared. At month 13, the haematological parameters persisted stable, with no need of maintenance therapy. The dramatic improvement after rituximab administration seems to support a role of B cells in the pathogenesis of CIDP, at least in cases associated with IgM lymphoproliferative diseases, regardless of the presence of antibodies to peripheral nerve antigens. Source: “Rituximab-Responsive CIDP”. C. Briania et al, Departments of Neurosciences and Clinical Immunology, University of Padova, Padua; Italy, 9 February 2004) [/QUOTE]

And here excerpts of the other case, a 73 year old woman:

[QUOTE]Rituximab was started in a dosage of 375 mg/m2 once weekly for 4 weeks. At the end of the treatment, anti-MAG antibodies titer was unchanged, whereas … IgM titer… decreased. At 1-month follow-up, clinical picture and disability had markedly worsened. The patient became wheelchair-bound because of ataxia, strength of distal muscles in the limbs worsened… Clinical picture was unchanged at 6- and 9-month follow-up…
Despite complete inhibition of CD20+ cells and decrease in IgM level, anti-MAG titer remained unchanged. This might imply that pathogenic antibodies were produced either by CD20+ cells at maturative stages (plasma cells – Norb) when rituximab is ineffective or by different B-cell subpopulations. As rituximab may induce a worsening of the clinical picture in some patients, further studies addressing the features of potential responders are warranted before larger clinical trials in anti-MAG. Source: Broglia et al. “Worsening after Rituximab in antiMAG Neuropathy”. Muscle & Nerve, Volume 32, Issue 3, Pages 378-379 [/QUOTE]