{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T23:10:19Z","timestamp":1779145819751,"version":"3.51.4"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":47,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Rituximab, an anti-cluster of differentiation 20 (anti-CD20) monoclonal antibody, has been widely used off-label for multiple sclerosis (MS) treatment, demonstrating high effectiveness and a favorable safety profile. However, real-world data from Brazil, particularly within the public healthcare system, remain scarce.<\/jats:p>\n                  <jats:p>To assess the real-world effectiveness and safety of rituximab for MS treatment in a Brazilian tertiary center.<\/jats:p>\n                  <jats:p>We conducted a single-center, observational study at Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo (HCFMUSP), including MS patients treated with rituximab between January 2016 and October 2024. The primary outcome was the change in annualized relapse rate (ARR) following rituximab initiation. The secondary outcomes included disability progression, radiological activity, and safety. The statistical analyses employed non-parametric tests and time-to-event analysis.<\/jats:p>\n                  <jats:p>Among the 45 patients (25 with relapsing-remitting MS [RRMS], 18 with secondary progressive MS, and 2 with primary progressive MS), rituximab reduced the ARR by 89.8% (from 0.49\u20130.05; p\u2009&lt;\u20090.001), with 90.9% remaining relapse-free. In RRMS patients, the ARR significantly decreased, from 0.56 to 0.17, after rituximab initiation (p\u2009=\u20090.019), with 88% remaining relapse-free (95%CI: 68.8\u201397.5). Radiological activity was observed in 6.8% of the sample. Patients with breakthrough disease activity (n\u2009=\u20094; 8.9%) presented more frequent prior natalizumab use than those without it (75.0% versus 43.9%; p\u2009=\u20090.039), as well as higher pretreatment relapse rates (1.8 versus 0.7; p\u2009=\u20090.033). Infusion-related reactions affected 12 (26.7%) patients, and they were mostly mild, while infections were the most common non-infusion adverse event (20; 57.8%). In total, 4 patients discontinued rituximab, mainly due to access limitations.<\/jats:p>\n                  <jats:p>Rituximab demonstrated high effectiveness and acceptable safety for MS treatment in a Brazilian public healthcare setting. Its favorable risk-benefit profile supports broader adoption in resource-limited contexts.<\/jats:p>","DOI":"10.1055\/s-0046-1820528","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T22:54:16Z","timestamp":1779144856000},"page":"001-009","source":"Crossref","is-referenced-by-count":0,"title":["Real-world experience with rituximab for multiple sclerosis treatment in a Brazilian tertiary center"],"prefix":"10.1055","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3319-7281","authenticated-orcid":false,"given":"Ana Beatriz","family":"Simon-Nogueira","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Divis\u00e3o de Neurologia, Grupo de Neuroimunologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4127-2366","authenticated-orcid":false,"given":"Arthur Ces\u00e1rio de","family":"Holanda","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Divis\u00e3o de Neurologia, Grupo de Neuroimunologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5196-9635","authenticated-orcid":false,"given":"Rafael Augusto","family":"Rosalem","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Divis\u00e3o de Neurologia, Grupo de Neuroimunologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2307-3758","authenticated-orcid":false,"given":"Thiago Ivan Vilchez","family":"Santillan","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Divis\u00e3o de Neurologia, Grupo de Neuroimunologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9764-3763","authenticated-orcid":false,"given":"Guilherme Diogo","family":"Silva","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Divis\u00e3o de Neurologia, Grupo de Neuroimunologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3493-1199","authenticated-orcid":false,"given":"Samira Luisa","family":"Apostolos-Pereira","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Divis\u00e3o de Neurologia, Grupo de Neuroimunologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5008-2783","authenticated-orcid":false,"given":"Tarso","family":"Adoni","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Divis\u00e3o de Neurologia, Grupo de Neuroimunologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0077-173X","authenticated-orcid":false,"given":"Dagoberto","family":"Callegaro","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Divis\u00e3o de Neurologia, Grupo de Neuroimunologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8985-8836","authenticated-orcid":false,"given":"Mariana Gondim","family":"Spricigo","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Divis\u00e3o de Neurologia, Grupo de Neuroimunologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5914-8099","authenticated-orcid":false,"given":"Mateus Boaventura de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo, Faculdade de Medicina, Hospital das Cl\u00ednicas, Divis\u00e3o de Neurologia, Grupo de Neuroimunologia, S\u00e3o Paulo SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"issue":"9648","key":"ref1","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.1016\/S0140-6736(08)61620-7","article-title":"Multiple sclerosis","volume":"372","author":"A 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