In MS, less frequent treatment dosing schedule is equally effective
Analysis finds no worse progression with fewer doses of anti-CD20 therapies
People with multiple sclerosis (MS) may receive less frequent treatments with anti-CD20 therapies without increasing their risk of disease activity or disability progression.
That’s according to a new meta-analysis of published studies that investigated the use of different dosing schedules for anti-CD20 therapies — approved treatments that deplete the immune B-cells that drive inflammation in MS. These therapies also suppress immune responses in general, so they come with an increased risk of serious infection, the researchers noted.
Alternative dosing strategies, such as extended-interval dosing, aim to “strike a balance between effectively controlling MS and minimizing long-term risks like infections while also making treatment more convenient and accessible for patients,” the team wrote.
This study examined the use of a less frequent dosing schedule for treatment, with the scientists reporting that “our meta-analyses regarding the [extended-interval dosing] of anti-CD20 [therapies] revealed that this strategy did not increase the risk of relapse, radiological activity, [or] disability progression” among patients.
According to the team, “our findings highlight the viability of [alternate dosing strategies] in treating MS, particularly in [patients] who are more prone to experience adverse effects from anti-CD20 [therapies].”
The study, “Efficacy of alternative vs. standard dosing strategies of anti-CD20 monoclonal antibodies in multiple sclerosis: A systematic review and meta-analysis,” was published in the journal Multiple Sclerosis and Related Disorders.
Anti-CD20 therapies target the CD20 protein on the surface of mature B-cells, a type of immune cell that plays a central role in driving the autoimmune attacks in MS. Administered regularly by injection under the skin (subcutaneously) or infusion into the bloodstream (intravenously), these therapies are designed to deplete B-cells and lessen MS-driving inflammation, thereby reducing relapse rates and the risk of disability progression.
However, because anti-CD20 therapies eliminate B-cells, they can also affect immune responses more broadly. Complications include low antibody levels and white blood cell counts, which come with an increased risk of serious infections and reduced vaccine effectiveness.
Scant data available on less frequent vs. standard dosing schedules
In light of these complications, alternative dosing strategies, such as lower doses and extended-interval dosing, have been proposed to control MS while minimizing long-term infection risks. Even so, there’s still a lack of comprehensive data comparing alternative versus standard dosing regimens.
To address this gap, a research team in Iran conducted a meta-analysis — a pooled assessment of published studies — that evaluated the effectiveness of these alternative approaches for anti-CD20 therapies in MS.
“By analyzing the available data, this study aimed to provide valuable insights that could inform clinical practice and guide future research toward optimizing treatment regimens for better patient care,” the team wrote.
A database search yielded 19 studies published between 2018 and 2024, all conducted in the U.S. or Europe. Of them, 16 assessed extended-interval dosing and three reported on dose reductions. The majority of studies (13) investigated changes in the dosing of Ocrevus (ocrelizumab), while five studied rituximab (sold as Rituxan, and others), and one examined Kesimpta (ofatumumab).
By analyzing the available data, this study aimed to provide valuable insights that could inform clinical practice and guide future research toward optimizing treatment regimens for better patient care.
A pooled analysis of 13 studies involving 4,560 MS patients found no difference in the rate of relapses, or when symptoms rapidly worsen, between those who received extended-interval versus standard dosing.
Likewise, the team found no differences in MRI activity across 11 studies involving 2,721 MS patients. Specifically, the number of participants with new or expanding lesions was similar regardless of dosing strategy.
Dose reduction also showed ‘promising results’
Seven of the studies analyzed assessed disability progression among a total of 1,484 MS patients. All showed the same pattern of similar results even with different dosing schedules.
There also were six studies that examined patients for no evidence of disease activity, or NEDA-3 — a measure indicating that an individual has had no relapses, no worsening disability, and no new MRI activity. Again, whether patients received extended or standard dosing regimens did not significantly affect their NEDA-3 status.
In studies reporting on dose reductions, one showed stable relapse rates and MRI activity with lower doses of Kesimpta. In two studies, relapses and lesions remained stable with lower doses of rituximab, and one also showed that disability progression remained similarly stable.
“[Extended-interval dosing] does not increase the risk of relapse, MRI activity, disability progression, or NEDA loss,” the researchers concluded. “While dose reduction also shows promising results, further evidence is needed for firm conclusions.”
The scientists noted several limitations regarding this work, namely the small number of studies ultimately reviewed. As such, the team called for randomized clinical trials “to enable more reliable … outcomes.”
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