Project Summary

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final. In the meantime, results have been published in peer-reviewed journals, as listed below.

PCORI has identified multiple sclerosis (MS) as an important research topic. Patients, clinicians, and others want to learn how different treatment strategies, aimed at changing specific symptoms or the overall course of MS, affect patients’ symptoms and quality of life. To address this issue, PCORI launched a funding initiative in 2015, Treatment of Multiple Sclerosis. This research project is one of the studies PCORI awarded as part this program.

What is the research about?

About 400,000 Americans have MS. This health problem affects the brain and spinal cord. MS can cause fatigue, numbness, vision changes, bladder problems, and mobility issues. Relapsing-remitting MS is the most common form of MS. Patients with this type of MS have attacks, with new or worse symptoms, followed by periods when symptoms get better.

Although there is no cure for MS, medicines can reduce the number and seriousness of MS attacks for people with the most common type of MS. Previous studies have shown that rituximab, a drug approved to treat some cancers and other diseases, can also treat relapsing-remitting MS. However, the US Food and Drug Administration hasn’t approved this medicine for MS. Also, doctors don’t know how well this medicine or other commonly used MS medicines work over many years, or whether they are safe when patients take them for a long time.

Researchers want to know how rituximab and other medicines compare over many years at improving patients’ quality of life. They want to know if the medicines work differently for patients who were just diagnosed with MS than they do for patients whose illness is more advanced. They also want to know how safe or effective rituximab is compared with other treatments for patients who have already tried another MS medicine.

Who can this research help?

This research can help doctors and patients decide what medicine to try first to treat relapsing-remitting MS. This research can also help doctors and patients choose a new medicine if another medicine doesn’t work as hoped.

What is the research team doing?

The research team is studying information from a Swedish database of patients with MS. The team also is collecting information from patients in Southern California who have MS. Every year for at least three years, researchers collect information about patients’ overall health, their MS, and quality of life. Using the national database helps researchers understand how medicines affect MS symptoms for a large number of patients. Using the information from patients in Southern California helps researchers find out how safe the medicines are over time. The research team expects to include information from about 6,000 patients by the end of the study. Because some patients started taking MS medicines several years before joining the study, researchers have information about how MS medicines affect these patients’ symptoms for up to nine years.

Researchers are looking at how well the medicines prevent MS symptoms and maintain quality of life. Researchers are also looking at whether safety issues like dangerous side effects cause patients to stop taking MS medicines.

The research team is working with patients with MS, families, caregivers, patient organizations, neurologists, scientists, and neurology organizations in the United States and Sweden. The group provides advice about how to carry out the study and what to measure. For example, the group suggested that the researchers measure both patient disability and quality of life.

Research methods at a glance

Design Element Description
Design Observational: cohort study
Population Adults aged 18 years and older with relapsing-remitting MS in Sweden and Southern California
  • rituximab
  • natalizumab
  • fingolimod
  • alemtuzumab
  • interferon beta-1a
  • glatiramer acetate​
  • dimethyl fumarate

Primary: disease progression, disease-related impact on quality of life

Secondary: safety, including serious adverse reactions, relapse rate, number of contrast-enhancing lesions; time on drug, treatment satisfaction, quality of life, fatigue, employment

Timeframe Timeframe Length of follow-up for collecting data on primary outcomes. View Glossary 3- to 9-year follow-up for primary outcomes

Journal Citations

Article Highlight: Through a research funding enhancement, which this study received in 2020 to quickly initiate new research related to COVID-19, the team comparing the safety and effectiveness of long-term medicines used to treat multiple sclerosis (MS) used its enhancement to see whether patients taking these drugs were more likely to be hospitalized or die from COVID-19 than the public. As reported in the Annals of Clinical and Translational Neurology, patients with MS treated with the drug rituximab were at increased risk of hospitalization but not ventilatory support or death from COVID‐19 compared to the general population.

Related Journal Citations

Project Information

Fredrik Piehl, MD, PhD
Karolinska Institute (Sweden)
Rituximab in Multiple Sclerosis: A Comparative Study on Effectiveness, Safety, and Patient-Reported Outcomes

Key Dates

July 2016
September 2023

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
Last updated: January 20, 2023