Evaluating rituximab for treating chronic fatigue syndrome

An Exploratory, Placebo-controlled, Double-blind, Phase II Study of the Efficacy and Safety for Rituximab (Genetical Recombination) in Myalgia Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

This study is testing if the medication rituximab can help people with chronic fatigue syndrome feel better compared to a placebo.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 30 (estimated)
• Ages: 18 Years to 65 Years
• Sex: All
• Sponsor: National Center of Neurology and Psychiatry, Japan (other)
• Drugs / interventions: rituximab
• Locations: 1 site (Kodaira, Tokyo)
• Trial ID: NCT06952413 on ClinicalTrials.gov

What this trial studies

This study investigates the efficacy and safety of rituximab, a CD20 antibody, in patients diagnosed with myalgia encephalomyelitis/chronic fatigue syndrome (ME/CFS). It employs a placebo-controlled, double-blind design where participants will receive either rituximab or a placebo during the primary evaluation period. Following this, participants will switch treatments to assess the timing and duration of rituximab's effects. The study aims to provide insights into the potential benefits of rituximab for ME/CFS symptoms.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 to 65 diagnosed with ME/CFS who meet specific severity criteria.

Not a fit: Patients with fatigue not meeting ME/CFS diagnostic criteria or those with severe hypersensitivity to rituximab will not benefit from this study.

Why it matters

Potential benefit: If successful, this study could offer a new treatment option for patients suffering from ME/CFS.

How similar studies have performed: While there have been studies on rituximab for other conditions, this specific application for ME/CFS is novel and has not been extensively tested.

Eligibility criteria

Inclusion Criteria:

1. Patients diagnosed with ME/CFS who meet the Canadian criteria by a physician.
2. Patients with a severity score of 4 or higher on the Performance Status (PS) based ME/CFS severity classification by the Ministry of Health, Labour and Welfare Research Group
3. Patients who are between 18 and 65 years of age at the time of obtaining written consent
4. Patients who can be hospitalized (hospitalized from the day before administration and discharged the day after administration) at the time of the first dose of each of the primary and secondary evaluation periods
5. Patients whose written consent has been obtained

Exclusion Criteria:

1. Patients with a history of severe hypersensitivity or anaphylactic reactions to components of rituximab or products derived from mouse protein
2. Patients whose cardiopulmonary function is judged by the treating physician to be not maintained
3. Patients complaining of fatigue that does not meet the diagnostic criteria for ME/CFS
4. Patients found to have other medical conditions that may cause symptoms
5. Patients who are pregnant, lactating, or have a positive pregnancy test (serum human chorionic gonadotropin test) at the time of enrollment
6. Patients with coexisting or pre-existing malignant tumors (excluding basal cell carcinoma of the skin and cervical dysplasia)
7. Patients with coexisting or pre-existing severe immune system diseases (excluding autoimmune diseases such as thyroiditis and type 1 diabetes)
8. Patients with a history of systemic immunosuppressive therapy (e.g., immunoglobulin therapy, azathioprine, cyclosporine, mycophenolate mofetil, etc.) within 1 year, a history of receiving drugs such as monoclonal antibodies acting on the immune system (e.g., anti-CD20 antibody products including rituximab), or a history of comorbidities requiring treatment with immunosuppressive drugs Patients with comorbidities requiring treatment with immunosuppressive agents (excluding treatment with low-dose steroids of 5 mg /day or less)
9. Patients who have started alternative medicine (reference: acupuncture, moxibustion, and Japanese warm therapy) within 12 weeks prior to the start of treatment with the investigational drug.
10. Patients with severe endogenous (primary) depression
11. Patients with a neutrophil count \<1.5\*103/microliter and platelet count \<10.0\*104/microliter on blood test
12. Patients with impaired renal function (serum creatinine level \> 1.5 times the upper limit of the reference value at the institution)
13. Patients with impaired hepatic function (serum bilirubin, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT) levels exceeding 1.5 times the upper limit of the reference value of the institution)
14. Patients infected with Human Immunodeficiency Virus (HIV)
15. Patients who test positive for at least one of Hepatitis B surface (HBs) antigen, HBs antibody, Hepatitis B core (HBc) antibody, or Hepatitis C virus (HCV) antibody.

    However, patients who meet the following conditions (1) and (2) may be registered.

    (i) Patients who are positive for HBs or HBc antibodies and whose HBV-DNA quantification is confirmed to be negative (less than detection sensitivity) and for whom appropriate monitoring, etc. can be conducted in accordance with the Guidelines for Hepatitis B Treatment edited by the Japan Society of Hepatology.

    (ii) For patients with positive HCV antibody, when HCV-RNA quantification is negative (less than detection sensitivity)
16. Patients who do not have the ability to comply with the study protocol
17. Patients who have participated in other clinical trials or clinical studies (except for observational studies without intervention) within 16 weeks prior to obtaining consent
18. Other patients who are judged by the investigator or subinvestigator (hereinafter referred to as investigator) to be inappropriate to participate in this clinical trial.

Where this trial is running

Kodaira, Tokyo

• National Center of Neurology and Psychiatry — Kodaira, Tokyo, Japan (RECRUITING)

Study contacts

• Principal investigator: Tomoko Okamoto, MD — National Center of Neurology and Psychiatry
• Study coordinator: Takami Ishizuka, PhD

Conditions: Myalgia Encephalomyelitis/Chronic Fatigue Syndrome