Polyneuropathy
Conditions
Keywords
Anti-MAG monoclonal gammopathy, Polyneuropathy, Rituximab
Brief summary
Polyneuropathy associated with anti-MAG monoclonal IgM gammopathy is responsive of mainly a sensory deficit in predominantly males ,aged 40-70 years. Significantly high serum anti-MAG antibodies are linked with demyelinating features of the peripheral nerves.Rituximab, an anti-CD 20 monoclonal antibody is a new drug which reduces B-lymphocytes. This study will test the safety and efficacy of rituximab in the treatment of patients with anti-MAG polyneuropathy.
Detailed description
Acting of a polyneuropathy for which there is not any treatment of reference today (see supra), a test of double-knowledge versus placebo is justified. Acting of a chronic polyneuropathy, the clinical evaluation must be led over one one year period. Acting of a sensitive polyneuropathy and the awaited benefit being the IMPROVEMENT OF the CLINICAL SIGNS, the principal criterion is a sensitive score in addition validated in chronic sensitive polyneuropathies immunodeficiency syndrome. The patients answering the criteria of inclusion and none inclusion (see V-2) will be randomized in 2 groups: the first group will receive a perfusion IV of rituximab to the amount of 375 mg/m2 of body surface, once per week, during 4 weeks (see VII-3); the second group will receive 4 perfusions IV of placebo according to same methods'. The evaluation (see VI-1) will be carried out at the time of the randomization, then repeated in 3 months, 6 months, 9 months and 1 year.
Interventions
Rituximab
Sponsors
Study design
Eligibility
Inclusion criteria
* IgM monoclonal gammopathy * Anti-MAG antibody titers \> 1.1000 BTU (ELISA) * Worsening polyneuropathy with INCAT score \> 4 * Informed consent
Exclusion criteria
* Severe comorbidity * Other concurrent causes of polyneuropathy * Concurrent immunosuppressive therapies (wash-out \> 3 months) * Previous treatment with rituximab * Lymphoproliferative disease indicating other immunosuppressive treatment * Unability to follow-up * Previous documented side-effects with components involved in the tested drug * White cell count \< 1500/mm3 or platelet count \< 75.000/mm3 * Patient under law
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| INCAT sensory score at 1 year | during de study | INCAT sensory score at 1 year |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Functional scales, MRC score | during the study | Functional scales, MRC score |
| Quality of life (SF 36) | during the study | Quality of life (SF 36) |
| Serum lymphocytes count, IgM level, anti-MAG antibody titers | during the study | Serum lymphocytes count, IgM level, anti-MAG antibody titers |
| Electrophysiological parameters | during the study | Electrophysiological parameters |
Countries
France