Ublituximab Treatment for Multiple Sclerosis and Rheumatoid Arthritis in a Patient with Insulin Dependent Diabetes: A Case Report

The introduction of monoclonal antibodies has radically changed the field of neuroimmunology and specifically for multiple sclerosis, the monoclonal antibodies targeting B-cells have proven to be very effective therapeutic agents. However, the not uncommon scenario of the co-existence of more than one autoimmune disorder in single patients poses the challenge of attempting to minimize the risks of complications brought on by overlapping multiple immune therapies. The preferable option would be to use one treatment that would combine efficacy across the different diseases. Because randomized clinical trials testing new treatments are not typically designed to investigate effects on patients with two or more immune diseases, case reports provide some evidence-based medicine for clinicians. Here we describe a remarkable clinical improvement observed with two administrations of ublituximab in a 45 year-old male who had juvenile onset of insulin dependent diabetes and had been diagnosed with multiple sclerosis more than ten years earlier. Besides a short course of steroids at the time of diagnosis, the patient had not received any prior disease modifying therapy for multiple sclerosis, and at the time of presentation at our center, he manifested signs and symptoms that led to the new diagnosis of rheumatoid arthritis. With details on the clinical features and laboratory results, this case illustrates the unprecedented attempt to treat the combination of multiple sclerosis and rheumatoid arthritis with ublituximab. An early treatment with a disease modifying therapy capable of a radical impact on the inflammatory activity underlying both multiple sclerosis and rheumatoid arthritis could be viewed as a probable factor for a favorable outcome.