Rituximab for MS linked to an eight-fold higher rate of new bowel inflammation than other therapies

The edition in brief

Today's neurology edition opens with a US Medicaid study of 21,923 people with epilepsy prescribed a hormonal contraceptive susceptible to enzyme induction (Neurology, 7 October). One in three (32.6%) overlapped for at least two weeks with an enzyme-inducing antiseizure medicine, typically for about seven months. Overlap was more likely with intellectual disability, drug-resistant epilepsy and age over 35. A meta-analysis of 17 studies of argatroban added to antiplatelet therapy in acute ischaemic stroke (published 22 October) found no gain in the main functional outcome (mRS 0–2, RR 1.03) and about half the rate of early neurological deterioration, but in randomised trials alone, intracranial and composite bleeding rose. The pearl is the glucose check before any stroke pathway decision. The practice changer is a Swedish register cohort (JAMA Neurology, 22 October) of 13,748 treatment starts in relapsing MS: new inflammatory bowel disease occurred at 110 per 100,000 person-years with rituximab, against 13 with natalizumab, dimethyl fumarate or fingolimod and 41 in the general population. After adjustment, the other drugs carried a tenth of the rituximab risk, with one extra case for every 131 people treated for five years, and most rituximab cases were Crohn disease. The study is observational and covers rituximab, not ocrelizumab or ofatumumab directly, but it is enough to ask about bowel symptoms before and during anti-CD20 treatment.