B-cell Depletion Using the Monoclonal Anti-CD20 Antibody Rituximab in Chronic Fatigue Syndrome

Study Description

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Brief Summary:

Based on pilot patient observations, and experience from the prior study KTS-1-2008, the investigators anticipate that chronic fatigue syndrome patients may benefit from B-cell depletion therapy using Rituximab induction with maintenance treatment.

The hypothesis is that at least a subset of CFS patients have an activated immune system involving B-lymphocytes, and that prolonged B-cell depletion may alleviate symptoms.

Condition or disease	Intervention/treatment	Phase
Chronic Fatigue Syndrome; Myalgic Encephalomyelitis	Drug: Rituximab	Phase 2

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	29 participants
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	B-lymphocyte Depletion Using the Monoclonal Anti-CD20 Antibody Rituximab in Chronic Fatigue Syndrome. An Open Label Phase II Study With Rituximab Induction and Maintenance Treatment
Study Start Date :	October 2010
Actual Primary Completion Date :	February 2014
Actual Study Completion Date :	February 2014

Arms and Interventions

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Arm

Intervention/treatment

Experimental: Rituximab; Rituximab induction using two infusions (500mg/m2, max 1000 mg) two weeks apart, followed by maintenance Rituximab infusions (500 mg/m2, max 1000 mg) after 3, 6, 10 and 15 months.

Drug: Rituximab; Two infusions of Rituximab 500 mg/m2 (max 1000 mg) given two weeks apart, followed by maintenance Rituximab infusions 500 mg/m2 (max 1000 mg) at 3, 6, 10, and 15 months. Approved amendment: for patients with gradual improvement in CFS/ME symptoms after 12 months follow-up, but not having reached a clear response, up to 6 additional Rituximab infusions (500 mg/m2, max 1000 mg) may be given during the following 12 months period.

Outcome Measures

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Primary Outcome Measures :

1. Symptom alleviation, as compared to baseline, measured by standardized self-reports and quality of life schemes. [ Time Frame: Major response of at least six weeks duration, independent on when occuring, during the follow-up period. ]
   The primary endpoint is defined as major response of the CFS symptoms, of at least six weeks duration, independent on when during 36 months follow-up the response period(s) occurs. Single such response periods, and the sum of these, are recorded.

Secondary Outcome Measures :

1. Symptom alleviation, as compared to baseline, measured by standardized self-reports and quality of life schemes. [ Time Frame: At 3, 6, 10, 15, 20, 24, 30, 36 months after intervention ]
   The secondary outcome measures are effect on the CFS symptoms, by evaluation at 3, 6, 10, 15, 20, 24, 30, and 36 months after first intervention (i.e. first Rituximab infusion)

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 66 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• patients with CFS
• age 18-66 years
• informed consent

Exclusion Criteria:

• patients with fatigue, not fulfilling criteria for CFS
• pregnancy or lactation
• previous malignant disease except basal cell carcinoma of skin and cervical carcinoma in situ
• previous major immunological disease, except autoimmune diseases such as diabetes mellitus or thyroiditis
• previous long-term use of immunosuppressive drugs, except steroids e.g. in obstructive lunge disease
• endogenous depression
• lack of ability to comply by the protocol
• multi-allergy with risk of serious drug reaction
• reduced renal function (creatinin > 1.5 x UNL)
• reduced liver function (bilirubin or transaminases > 1.5 x UNL)
• HIV positivity
• evidence of clinically significant infection

Contacts and Locations

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Locations

Norway
Department of Oncology, Haukeland University Hospital
Bergen, Norway, N-5021

Sponsors and Collaborators

Haukeland University Hospital

Investigators

Principal Investigator:	Olav Mella, PhD, MD	Haukeland University Hospital

More Information

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Publications:

Fluge Ø, Mella O. Clinical impact of B-cell depletion with the anti-CD20 antibody rituximab in chronic fatigue syndrome: a preliminary case series. BMC Neurol. 2009 Jul 1;9:28. doi: 10.1186/1471-2377-9-28.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Fluge Ø, Risa K, Lunde S, Alme K, Rekeland IG, Sapkota D, Kristoffersen EK, Sørland K, Bruland O, Dahl O, Mella O. B-Lymphocyte Depletion in Myalgic Encephalopathy/ Chronic Fatigue Syndrome. An Open-Label Phase II Study with Rituximab Maintenance Treatment. PLoS One. 2015 Jul 1;10(7):e0129898. doi: 10.1371/journal.pone.0129898. eCollection 2015.

Responsible Party:	Haukeland University Hospital
ClinicalTrials.gov Identifier:	NCT01156909 History of Changes
Other Study ID Numbers:	2010/1318
First Posted:	July 5, 2010
Last Update Posted:	September 1, 2014
Last Verified:	August 2014

Keywords provided by Haukeland University Hospital:

Chronic fatigue syndrome; CFS; Myalgic encephalomyelitis; Rituximab; B-cell depletion

Additional relevant MeSH terms:

Syndrome; Fatigue; Fatigue Syndrome, Chronic; Encephalomyelitis; Myalgia; Disease; Pathologic Processes; Signs and Symptoms; Virus Diseases; Muscular Diseases; Musculoskeletal Diseases; Central Nervous System Diseases	Nervous System Diseases; Neuromuscular Diseases; Central Nervous System Infections; Musculoskeletal Pain; Pain; Neurologic Manifestations; Rituximab; Antibodies; Antineoplastic Agents; Immunologic Factors; Physiological Effects of Drugs; Antirheumatic Agents