New Study Explores Addressing CFS with Rituximab

A study published in PLoS (Public Library of Science) adds a new potential therapy approach for CFS and fibromyalgia — a medication called "Rituximab."

The immune system has several different arms — just like the military has the Army, Navy and Air Force. Two of these arms of defense are called the Th1 and Th2. When you have CFS, the Th2 of your immune system goes into overdrive — an imbalance that makes it hard for your body to fight certain types of infections and over time can exhaust your immune system.

The new PLoS study uses an intravenous prescription medication called Rituximab, which is used to address lymphomas (blood cell cancers) and autoimmune diseases such as rheumatoid arthritis. Although you may hear it being called a chemotherapy agent, it does not have the same kinds of toxicity and is fairly low in side effects in CFS. In technical terms, it is an antibody that cause B-cell depletion, which lowers Th2 effect (no need to remember that ;-)

The study was placebo-controlled and included 30 people with chronic fatigue syndrome. Of the 15 people who received the active therapy, two thirds experienced a noticeable improvement — in some cases markedly so!

It took 2–7 months after therapy for people to start feeling better after the injections. The benefits lasted an average of 6 months (although in 2 people it lasted for the duration of the study). On average, patients rated themselves as "slightly improved," and during their best 6 week period in the study, those on the medication had a 40% drop in pain and 24% increase in vitality.

Therapies were given intravenously at the beginning of the study with a repeat dose 2 weeks after. They are now exploring giving booster shots every 3 months for several injections, and then spacing them out.

Though I consider this study to be very promising as an eventual therapy option — as well as being another study proving that CFS is a very real disease — it is worth keeping the following in perspective:

1. The cost of the medication for the 2 injections is about $11,500. And I suspect it will take much more research before insurance companies will approve it for CFS.
2. Some people receiving the medication experience severe infusion reactions. But this appears likely caused by die off of cancer cells, and was not seen in the CFS patients in this study. In real life, I suspect the toxicity in CFS would be on par with Motrin (or less).
3. The average improvement during the patients' best 6 weeks was a 24% increase in vitality (with a 40% drop in pain), and the benefits were often transient. In our ribose study, the average improvement in energy was 61%. And even before including the use of ribose as part of it, the SHINE protocol showed an average 90% improvement with additional gains continuing at 2 years. Another natural immune balancer called thymic protein is also available, and in 1 CFS study dropped Epstein Barr antibody levels 70% and improved symptoms after 3 months — easily, and at a tiny fraction of the cost. So other safer, more effective, and lower-cost therapies than Rituximab are readily available now.

Bottom Line

The PLoS study is very promising. Though it will likely take years before the Rituximab therapy is approved and covered by insurance in CFS, it is in wide use now for other conditions and could be considered in severe refractory cases (i.e., "when all else fails") as an experimental option. In most cases, though, I would NOT recommend it be used yet. In time, as we get more clinical experience with it, I could change my mind — but even then I suspect it would be recommended in only a very small percent of cases.

Rituximab is expensive and provides only transient benefit. As such I see it as a helpful tool. However, other low cost, easier and far more effective options are available now.