The Impact of Social Networks on Enhancing Safety and Efficacy Outcomes in Low-Dose Rituximab Treatment for Central Nervous System Demyelinating Diseases

Document Type : Original Article


1 Assistant Professor and Chief of Neurosurgery Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Assistant Professor of Neurology Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Assistant Professor of Neurosurgery Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

4 Department of Neurology, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

5 Shefa Neuroscience Research Center, Khatam Al Anbia Hospital, Tehran, Iran

6 Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

7 The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran

8 Department of Anatomical Sciences, School of Medicine, Iran university of Medical Sciences, Tehran, Iran

9 Pharmacist, University College London, England, London

10 Medical Student, Iran university of Medical Sciences, Tehran, Iran


Background: In the realm of healthcare, the symbiotic relationship between social networks and medical advancements has attracted significant attention. This study aimed to explore the effectiveness and safety of this approach, with a particular focus on the role of social networks in disseminating information and shaping patient experiences.
Methods: In a prospective single-arm interventional study, we examined the effects of integrating social networks – Skype and WhatsApp – to enhance the safety and efficacy outcomes of low-dose Rituximab treatment for CNS Demyelinating Diseases. Patients eligible for treatment were recruited, and ethical consent was secured. The intervention involved informative Skype groups, led by medical experts, providing education and follow-up, and WhatsApp groups for peer support and question-answer sessions. Clinical data and interaction metrics were collected to evaluate treatment outcomes and engagement levels. 
Results: A total of 99 patients received rituximab, with 42 diagnosed with RRMS, 43 with SPMS, and 14 with NMOSD. The treatment period ranged from 12 to 40 months. Among the RRMS patients, 8 (19%) experienced new attacks, while 10 (23%) of the SPMS patients and 1 (7%) of the NMOSD patients had new attacks. In cases of RRMS and NMOSD, there was a decrease in EDSS scores. Additionally, SPMS and NMOSD patients showed a decrement in serum IgG levels. Two cases of drug adverse events were reported. Mean EDSS variability had a decrease in RRMS (-0.32, P=0.06) and NMOSD (-0.57, P=0.004) and had a slight increase among patients with SPMS (+0.19, P=0.23).
Conclusion: Recognizing the impact of social networks can lead to improved patient care and tailored support systems.


  1. Tsao S-F, Chen H, Tisseverasinghe T, Yang Y, Li L, Butt ZA. What social media told us in the time of COVID-19: a scoping review. The Lancet Digital Health. 2021;3 (3):e175-e94.
  2. Zhuravskaya E, Petrova M, Enikolopov R. Political effects of the internet and social media. Annual review of economics. 2020;12:415-38.
  3. Olanrewaju A-ST, Hossain MA, Whiteside N, Mercieca P. Social media and entrepreneurship research: A literature review. International Journal of Information Management. 2020;50:90-110.
  4. Eizaguirre MB, Ciufia N, Roman MS, Canyazo CM, Alonso R, Silva B, et al. Perceived fatigue in multiple sclerosis: the importance of highlighting its impact on quality of life, social network and cognition. Clinical neurology and neurosurgery. 2020;199:106265.
  5. Mirmosayyeb O, Ghaffary E, Vaheb S, Pourkazemi R, Shaygannejad V. Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) following COVID-19 vaccines: a systematic review. Revue Neurologique. 2023.
  6. Kang J, Kim SY, Vallejo D, Hageman TS, White DR, Benet A, et al. Multifaceted assessment of rituximab biosimilarity: The impact of glycan microheterogeneity on Fc function. Eur J Pharm Biopharm. 2020;146:111-24.
  7. D’Amico E, Zanghi A, Chisari CG, Fermo SL, Toscano S, Arena S, et al. Effectiveness and safety of Rituximab in demyelinating diseases spectrum: An Italian experience. Mult Scler Relat Disord. 2019;27:324-6.
  8. Lavorgna L, Brigo F, Moccia M, Leocani L, Lanzillo R, Clerico M, et al. e-Health and multiple sclerosis: An update. Multiple Sclerosis Journal. 2018;24 (13):1657-64.
  9. Hernández-Rodríguez J, Carbonell C, Mirón-Canelo J-A, Diez-Ruiz S, Marcos M, Chamorro AJ. Rituximab treatment for IgA vasculitis: a systematic review. Autoimmunity Reviews. 2020;19 (4):102490.
  10. Rostami A, Abbasi Y, Jamalnia S, Asadian A, Enani H, Jafarinia M. Mesenchymal Stem Cells as A New Approach for the Treatment of Multiple Sclerosis: A Literature Review. Galen Medical Journal. 2022;11:e2529.
  11. Ortiz-Ospina E, Roser M. The rise of social media. Our world in data. 2023.
  12. Auxier B, Anderson M. Social media use in 2021. Pew Research Center. 2021;1:1-4.
  13. Farsi D. Social media and health care, part I: literature review of social media use by health care providers. Journal of medical internet research. 2021;23 (4):e23205.
  14. Zhao D, Zhao C, Lu J, Han Y, Sun T, Ren K, et al. Efficacy and safety of repeated low-dose rituximab therapy in relapsing-remitting multiple sclerosis: A retrospective case series study. Multiple Sclerosis and Related Disorders. 2023;70:104518.
  15. Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17 (2):162-73.
  16. Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85 (2):177-89.
  17. Lavorgna L, De Stefano M, Sparaco M, Moccia M, Abbadessa G, Montella P, et al. Fake news, influencers and health-related professional participation on the Web: A pilot study on a social-network of people with Multiple Sclerosis. Multiple sclerosis and related disorders. 2018;25:175-8.
  18. Costa WA, Monteiro MN, Queiroz JF, Gonçalves AK. Pain and quality of life in breast cancer patients. Clinics. 2017;72:758-63.
  19. Hawker K, O’Connor P, Freedman MS, Calabresi PA, Antel J, Simon J, et al. Rituximab in patients with primary progressive multiple sclerosis: results of a randomized double‐blind placebo‐controlled multicenter trial. Annals of neurology. 2009;66 (4):460-71.
  20. Scotti B, Disanto G, Sacco R, Guigli M, Zecca C, Gobbi C. Effectiveness and safety of Rituximab in multiple sclerosis: an observational study from Southern Switzerland. PLoS One. 2018;13 (5):e0197415.
  21. Greenberg BM, Graves D, Remington G, Hardeman P, Mann M, Karandikar N, et al. Rituximab dosing and monitoring strategies in neuromyelitis optica patients: creating strategies for therapeutic success. Multiple Sclerosis Journal. 2012;18 (7):1022-6.
  22. Zéphir H, Bernard-Valnet R, Lebrun C, Outteryck O, Audoin B, Bourre B, et al. Rituximab as first-line therapy in neuromyelitis optica: efficiency and tolerability. Journal of neurology. 2015;262 (10):2329-35.
  23. Ciron J, Audoin B, Bourre B, Brassat D, Durand-Dubief F, Laplaud D, et al. Recommendations for the use of Rituximab in neuromyelitis optica spectrum disorders. Revue neurologique. 2018;174 (4):255-64.
  24. Ali M, Bilal HSM, Razzaq MA, Khan J, Lee S, Idris M, et al. IoTFLiP: IoT-based flipped learning platform for medical education. Digital communications and networks. 2017;3 (3):188-94.
  25. Sakurai R, Kawai H, Suzuki H, Kim H, Watanabe Y, Hirano H, et al. Poor social network, not living alone, is associated with incidence of adverse health outcomes in older adults. Journal of the American Medical Directors Association. 2019;20 (11):1438-43.
  26. Ali F, El-Sappagh S, Islam SR, Ali A, Attique M, Imran M, et al. An intelligent healthcare monitoring framework using wearable sensors and social networking data. Future Generation Computer Systems. 2021;114:23-43.
  27. Neely S, Eldredge C, Sanders R. Health information seeking behaviors on social media during the COVID-19 pandemic among American social networking site users: survey study. Journal of medical Internet research. 2021;23 (6):e29802.