Independent confirmatory trials of the Norwegian results are crucial if rituximab is to be licensed for use in ME. Further, a UK trial will help raise the profile of ME in the UK as a disease demanding biomedical research. And if an immune therapy such as rituximab is shown to be successful in treating the condition it will help to establish ME as a non-psychological disease. This in turn will help to change public perception of ME, get better medical treatment for patients and unlock the floodgates to biomedical research funding.

The charity invited UK academic institutions to the BRMEC3 colloquium in May 2013 in order to gain interest in performing biomedical research which the charity wished to initiate. UCL expressed interest in assisting with this. After the BRMEC4 colloqium some work was performed to scope a trial.

After discussions with UCL it was decided to perform a preliminary study to identify likely responders using the work of Dr Amolak Bansal as a basis. This has been decided to be performed by the UCL research team. The charity has agreed to fund associated and complementary B-cell research at UCL with a PhD student. This will allow futher research to be performed which will add to the total knowledgebase and allow more confidence in the ability to determine likely responders.

After this work is completed then a clinical trial protocol has to be established in order for the trial to take place.
Applications to perform this resultant trial will be open to all and all applications will be externally peer reviewed to enable the charity to decide where the trial will take place.

As more work has been performed on scoping a trial the charity was given an initial estimate that the cost would be approximately £350,000. This may, of course, change as the initial B-cell study and further research progresses.
Obviously, the more funding we have then the more flexibility there is in performing a trial. Also reference should be made to the pages, here and on the Invest in ME website, to the collaboration which has been, and is taking place with the researchers in Hakeland University Hospital Bergen, Norway, where a Phase III trial is underway.

Our advisor, Professor Jonathan Edwards, has proposed that the best approach is to set up a trial treating about 30 patients with a focus on trying to identify which patients are most likely to benefit from rituximab. Some further preliminary laboratory work is likely to be needed before it is clear what design would be optimal.

Yes, it can and it will. Clinical trials by other groups are important and will provide the continuity and progress we look for. The Invest in ME IIMEC7 conference of 2012 highlighted the case for clinical trials [R2]. Our advisor, Professor Edwards, has invaluable expertise to offer.
Invest in ME earlier arranged a visit to Bergen where Professor Edwards discussed with the Norwegian researchers and discussing issues.
Further visits from the IiME-funded UCL team will be taking place - the collaboration with the Norwegian researchers, and others, is underway and ongoing.
Also, some may find the following attributed quote useful -

“Take Rituximab – suppose it turned out in most cases to be negative, but perhaps 10% might benefit from it? You could be missing a fantastic opportunity for that minority"

- Professor Stephen Holgate, Medical Research Council

Rituximab has been used for other diseases over a long period. The researchers, clinicians and consultants involved in any trial will provide extensive information before involvement and the official ethical and regulatory processes will be performed by the research team and clinical trials unit, as per similar projects.

No - at the moment the best option is to perform clinical trials which will determine efficacy and safety for ME patients.

This is an option which is being considered by the the charity and advisors.

The preliminary B-cell study to find responders will be based at University College London and is being set up in collaboration with clinicians with expertise in ME from around London, in particular Dr Amolak Bansal. After advice from our Advisory Board and, in order to meet proper selection criteria, the clinical trial will be open for organisations to apply and, after an external peer review process has been carried out, the charity will select the best candidate. This link provides details of the application process and the deadline.

Dr Jo Cambridge’s team has great laboratory experience in B-cell immunology.
Dr Cambridge is a Principal Investigator at UCL’s Centre for Rheumatology, one of the leading academic rheumatology units in the UK, which undertakes wide-ranging clinical studies of patients with autoimmune rheumatic diseases. We invited Dr Cambridge to our 2013 Biomedical Research into ME Collaborative Meeting, where her presentation and sincere and positive approach to progressing research added an enormous amount.
A clinical service was set up when Professor Edwards and his team started treating rheumatoid arthritis, lupus and a range of other autoimmune conditions with rituximab and there is extensive experience in this area in this team.

We are proud that Jonathan Edwards, Emeritus Professor of Connective Tissue Medicine at University College London, has agreed to act as our advisor for the trial. He raised the possibility that self-perpetuating B lymphocytes drive human autoimmune disease in a 1999 paper in Immunology and conducted the Phase I and ‘proof of concept’ Phase II studies of rituximab for rheumatoid arthritis published in the prestigious New England Journal of Medicine in 2004 that established the role of B cell depletion in autoimmune disorders. No UK expert is better placed than Professor Edwards to advise us on setting up a rituximab trial for ME patients. You can read his statement on the UK ME rituximab trial here.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2326840/    http://www.nejm.org/doi/full/10.1056/NEJMoa032534    http://www.investinme.org/Rituximab%20news-July13%2001.htm 

The UCL team are collaborating with Dr Amolak Bansal, who is the consultant immunologist and founder of the CFS service at St Helier Hospital and Dr Berkowitz (UCLH CFS clinic).
The team is also working in close liaison with the Norwegian researchers in Bergen where a Phase III trial is underway.
Professor Edwards has visited Bergen for discussions with Dr Fluge and Professor Mella and the charity will arrange further trips by the UCL team if needed.
Already planned is another visit in September 2015.
The teams are in regular communication and have been in discussion in the Invest in ME Biomedical Research into ME Colloquiums and international conferences.
This collaboration will undoubtedly help both the Norwegian and the UK studies.
The charity has also initiated and facilitated the formation of the European ME Research Group (EMERG) - a collaborative group of European researchers.

The preliminary B-cell study which was required to begin to understand potential responders has been underway at UCL since 2014.
A further IiME-funded B-cell research project has been initiated at UCL with Dr Cambridge and Fane Mensah working with Dr Amolak Bansal and Dr Berkowitz (UCLH CFS clinic).
The team is now collaborating with the Norwegian researchers, and others, to enable a more fuller understanding of the pathomechanism in order to make the planned trial as effective and productive as possible.

Invest in ME have run an annual international biomedical research conference on ME every year since 2006, now attended by representatives from most of the world’s main biomedical ME research teams.
The charity has also initiated a pre-conference Biomedical Research into ME Research Colloquium to foster collaboration amongst researchers, including a 2012 meeting on autoimmunity in collaboration with the Alison Hunter Memorial Foundation of Australia.
Autoimmunity is, of course, an important aspect of the possible mechanism of rituximab in ME.
The Colloquiums have become larger every year and in 2015 BRMEC5 had almost seventy researchers from thirteen countries attending.
We have drawn on our contacts with the international ME research community, including our European ME Alliance partners, to begin planning our UK trial.

We aim to raise the funds with the help of our supporters in Let's Do It for ME and anyone who shares our objectives for the study. A wonderful new scheme for fundraising has been developed - The MATRIX - which allows groups, organisations and individuals to raise funds by taking a slot in the Matrix and attempting to raise £1000 or more. Full details are available here.
The charity reached out to other organisations early on in the project and invited them to support our trial - both with publicity and with funding or pledges.
In return the charity would acknowledge the support and keep all informed of progress on a regular basis. For those who feel they need to review our project proposal further they may organise their own peer review process, as they deem necessary.
We welcome contributions from other organisations, companies, groups and individuals and will fully recognise any support given to us.
A number of organisations have already helped us with donations and pledges and also via publicising the project- see here

Yes. We have created a separate, ring-fenced fund and account details are provided on the Donate Page on this site.

None of it.
Invest in ME is run entirely by volunteers. There are no salaries and no funds will be used for administration costs.
All funds raised will be used in full for financing the UK rituximab project and associated research.
The funds are stored in a separate, ring-fenced bank account specifically used for the UK rituximab Trial.

In Norway, Dr Maria Gjerpe, a fully-recovered patient from Dr Fluge and Professor Mella’s pilot rituximab trial, set up the MEandYou Foundation and raised £280,000 for the confirmatory trial in only three months. Maria gained such a public profile for the trial that the government provided enough extra funding for the trial to begin.
The UK has many more people with ME than Norway and our initial trial will be smaller. The sum needed is less than that given recently by the MRC to researchers performing research in other areas connected to ME.
Update: In February 2015 the announcement was made of the £1/2 million of research funding having been reached by IiME supporters - click here.
The support of many people around the world has made this possible.
The Let's Do It For ME campaign has been instrumental in the positive campaigning and crowdfunding that has acheived this - click here

We are confident that the trial will go ahead but realise that it is important to be transparent about what will happen to the donated funds in the unlikely event that the rituximab project does not proceed.
In such a case, the funds raised will be transferred to the Invest in ME Biomedical Research Fund to fund other biomedical research into ME projects initiated by the charity.
This has been stated from the outset.

If more funds are received than are required for a rituximab trial then the excess funds raised will be transferred to the Invest in ME Biomedical Research Fund to fund other biomedical research into ME projects.

Our rituximab trial fundraising thermometer (click here) and our JustGiving page are frequently updated to show the total raised.
https://www.justgiving.com/ritux4meuk    

We launched our first fundraising project: the Matrix! We have more projects in the pipeline. We already have a number of pledges and offers of support and will continue to develop more, raising the profile both of this project and of ME as a disease requiring a biomedical approach.  

We welcome your support in the form of donating, fundraising, spreading word of the project, or simply letting us know that you are behind us in this effort.
We need to raise awareness and interest from as many sources as possible.

There is still a lot of work to be done before the trial is at a participant recruitment stage.
A trial protocol needs to be designed and ethical approval obtained etc. These things take time.
The patients would be selected via normal NHS referral pathways. Consultants involved in selecting the patients for the preliminary B-cell study are based at the Epsom and St Helier CFS clinic and at the UCLH CFS clinic in London.
In order to have a chance of being selected for the preliminary B-cell study one would need to be an existing patient at these clinics or be referred there as a normal NHS ME patient (not just for the purpose of the trial).
The actual clinical trial has not started yet and we are still fundraising to ensure we have sufficient contingency.
We would ask patients interested in any of the research funded by IiME not to contact the research teams directly as this inhibits their work and there is little they can do to help.
Invest in ME will be happy to answer questions on the research and status and direct people to the correct pathway.
The charity is not involved in the recruitment of patients in any research it funds as the ethics rules allow patient recruitment by the named consultant/s only.
However, the charity does request that patients involved in the research projects should be properly diagnosed using current criteria (at least Canadian), that severely affected patients are also considered for participation when appropriate, and that the research is on myalgic encephalomyelitis (ME - although ME/CFS is sometimes used to standardise on the term used in the CCG).
We have always built the strategy for developing services and research on the view that all treatments should eventually be available for all – and, in the UK, that means within the NHS.
Also it would be advisable for any patients who wish to enter clinical trials not to view them as personalised treatment but rather look at the bigger picture and see this trial as helping progress the research into ME.
At the moment the consultants involved in Invest in ME funded research (gut microbiota, B-cell study leading to rituximab trial) are Dr Bansal (Epsom and St Helier CFS clinic) and Dr Berkowitz (UCLH CFS clinic).
The easiest way to be considered for any of the research would therefore be to get a referral to these doctors - but one should not be referred for research purposes only as the researchers want everything to be as unbiased as possible.
The initial B-cell work being performed at UCL has been focusing on identifying patients that would be likely responders to rituximab.
The UCL team have been working closely with the Norwegians to jointly understand the pathomechanism.
In fact, the Norwegians specifically asked the UCL team to concentrate on just that and the charity has facilitated and worked for this collaboration.
This cooperation helps both teams as well as all patients in the end and continues.
So the trial will be determined on this research.
The researchers are very thorough and careful and want to be as certain as possible that they can identify an objective way of selecting patients.
So there is still time for patients to be selected in a future trial – but, as mentioned above, it isn’t for the charity to decide.
The fundraising for the rituximab project and associated B-cell research is ongoing.

Rituximab is a monoclonal antibody against the protein CD20, which is primarily found on the surface of immune system B cells. Rituximab destroys the B cells and so is used in autoimmune disorders, in which B cells play a role. Rituximab is also known by its trade names, Rituxan and MabThera.

Let’s Do It for ME is our fundraising and awareness campaign for biomedical research into ME, led by our supporters. It has its own website, Facebook page and blog and is playing a major part in raising funds for the rituximab trial.
website
facebook
blog

We will update this page with information about the trial as soon as it becomes available but if you have something you want to know but do not find it here then please email us at [email protected].
We will also accept questions using an interface on this site - click here