Anti-CD20 Therapies Do Not Slow Disability Worsening in Primary Progressive MS

Disability progression was no slower in patients with primary progressive multiple sclerosis (MS) treated with anti-CD20 infusion therapies than in untreated patients, according to a study of real-world patients published in Neurology.

“Anti-CD20 therapies are widely prescribed, in part because there are few alternate treatments,” said study author Laure Michel, MD, PhD, of Rennes University in Rennes, France. “However, our study suggests they may not slow disability from worsening for people with primary progressive MS.”

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The retrospective study included data for 1184 patients with primary progressive MS from a French MS registry. Between 2016 and 2021, 295 patients were treated with rituximab, 131 were treated with ocrelizumab, and 758 were untreated. Patients did not take any MS medications in the 2 years before the study’s start and had an Expanded Disability Status Scale score of 6.5 or less at baseline. The study followed patients an average 4 years.

Patients treated with anti-CD therapies were younger (with a median age of 51.9 years compared with 58.6 for untreated patients) and more of them had active disease (54.5% compared with 27.8% for untreated patients) at baseline, researchers reported.

The time to first confirmed disability progression did not differ between patients treated with anti-CD20 therapies and patients who were untreated, according to the study. 

In secondary analyses, researchers reported a nonsignificant trend toward fewer patients relapsing with anti-CD20 treatment. However, activity on magnetic resonance imaging did not differ significantly between the 2 groups. In treated patients, risk factors associated with disability progression were male sex and MS duration. 

Ocrelizumab is approved by the US Food and Drug Administration for primary progressive MS and for patients with relapses, but rituximab is an off-label treatment for patients with MS.

“Although our study is retrospective and mainly included patients treated by rituximab, our results indicate that there should be a constant evaluation of all available data to ascertain the best risk/benefit ratio for patients with primary progressive MS,” researchers wrote.

References

Hay M, Rollot F, Casey R, et al. Anti-CD20 therapies in drug-naive patients with primary progressive multiple sclerosis: a multicenter real-life study. Neurology. 2024;103(8):e209886. doi:10.1212/WNL.0000000000209886

Study finds certain MS therapies may not slow disability progression. News release. American Academy of Neurology; September 25, 2024. Accessed October 3, 2024.