Anti-CD20 Therapy and Disability Progression in Relapsing Multiple Sclerosis
DOI:
https://doi.org/10.5281/zenodo.22310428Keywords:
Anti-CD20 therapy, Multiple sclerosis, Disability progression, B-cell depletion, PIRAAbstract
Background: Anti-CD20 antibodies are now a dominant treatment class in relapsing multiple sclerosis (MS). Disability
accumulation is increasingly understood as driven by relapse-independent progression, not relapses alone.
Objective: To review trial, mechanistic, comparative and safety evidence on anti-CD20 therapy and disability outcomes in
relapsing MS. Methods: Narrative review of randomised trials, extension studies, registries and mechanistic literature on rituximab,
ocrelizumab, ofatumumab and ublituximab. Findings: OPERA I/II, ASCLEPIOS I/II and ULTIMATE I/II each showed reduced relapse rate and confirmed disability progression versus active comparators. Pooled analyses show most disability accumulation in relapsing MS reflects progression independent of relapse activity (PIRA), which anti-CD20 therapy also reduces. Real-world Swedish cohorts and comparative registries broadly support efficacy across agents; long-term safety data highlight hypogammaglobulinemia and infection risk. Conclusions: Anti-CD20 therapy slows both relapse-associated and relapse-independent progression, though agent selection,
dosing intervals and long-term immune monitoring remain active areas of study.
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