Rituximab Review

I noticed today on facebook that someone posted a link to a NewScientist article Antibody wipeout found to relieve chronic fatigue syndrome (1 July 2015) dealing with the use of Rituximab. This is an anti-cancer drug. Since 2002, I have personally met physically several CFSers that went into full remission of CFS after treatment for cancer. The results are very believable that  “Eleven of the 18 responders were still in remission three years after beginning the treatment, and some have now had no symptoms for five years”.

I know that cancer treatment results in a massive change of the microbiome (exactly what my model asks for!). For example:

So, we have Staphylococcus decrease and Escherichia increase – which is precisely the type of shift that I have been advocating….

What does PubMed say for CFS?

There are just 12 studies at the moment, newspaper reports tend to often tilt results to sell newspaper.

  • “Recently, two clinical trials of B cell depletion therapy with rituximab (anti-CD20) reported convincing improvement in symptoms.” [2016]
  • “In a subgroup of ME/CFS patients, prolonged B-cell depletion with rituximab maintenance infusions was associated with sustained clinical responses.” [2015]
  • “The delayed responses starting from 2-7 months after Rituximab treatment, in spite of rapid B-cell depletion, suggests that CFS is an autoimmune disease and may be consistent with the gradual elimination of autoantibodies preceding clinical responses.” [2011]

Bottom Line

We have a drug that causes remission in a subset of CFS patients [Fact]. The drug causes multiple effects: B-lymphocyte depletion and shift of the microbiome. Which effect (or a third unknown one) is the cause of remission?

IMHO the shift of the microbiome is more likely, many people have reported on this site (and by private email), significant improvement of symptoms by shifting the microbiome by just probiotics and supplements. There is no apparent link to B-lymphocyte with that treatment.

The model also predicts that any treatment will only be effective on subsets because the success is determined by the effectiveness of the treatment against the very specific strains that a person has. This is what is reported in the above literature — effective for a subset.

If you can get this prescribed by your MD, covered by insurance, and you fully understand the risks (see official literature), then give it a try. For myself, I would exhaust the appropriate probiotics and appropriate antibiotic paths first.