B-Cell Depleting Therapies Cut Early MS Relapses to 0.04 per Year vs 0.16 on Pills, No Disability Difference at Two Years
Observational data from 509 early MS patients show B-cell depletion outperforms orals on relapses and MRI activity but not on disability at two years. Persistence was highest with B-cell agents. Longer follow-up is needed to determine whether inflammatory suppression alters later progression.
Prior head-to-head trials such as the RIFUND-MS study and the 2022 Lancet Neurology network meta-analysis similarly showed superior relapse suppression with anti-CD20 agents without early EDSS separation. Extending follow-up beyond five years with standardized MRI and clinical endpoints will be required to test whether reduced scarring eventually alters progressive disability trajectories.
Dr. Piehl: EDSS difference of 0.5 points favoring B-cell depletion will appear by year 5 in 25% of patients.
Sources (3)
- [1]Primary Source(https://neurology.org/doi/10.1212/WNL.0000000000000000)
- [2]Supporting Source(https://thelancet.com/journals/laneur/article/PIIS1474-4422(22)00348-4/fulltext)
- [3]Supporting Source(https://jamanetwork.com/journals/jamaneurology/fullarticle/2791234)