Welcome back to another Neurology Live Peer Exchange series. In this episode titled "Evolving MS Diagnostic Criteria: 2024 McDonald Criteria and What's New," moderator Dr. Mitzi Joi Williams discusses multiple sclerosis with Dr. Stephen Krieger.
In this episode, panelists explore the question of "MS Treatment Strategy: High-Efficacy Therapy vs. Escalation Approach." Dr. Williams frames the central question: with earlier MS diagnoses now possible, how has treatment philosophy shifted? The traditional "start low, go slow" escalation model has given way to a high-efficacy-first approach for many clinicians.
How MS therapy choices balance patient preference, payer coverage, dosing convenience, and family planning as high-efficacy options expand.
In this episode focused on first-line MS treatments, Dr. Williams poses the practical question: when a newly diagnosed, treatment-naive patient with relapsing-remitting MS sits across from you, what guides your treatment recommendation?
In "Why Anti-CD20 Therapy Has Become a Cornerstone of MS Treatment" episode, panelists explore the anti-CD20 drug class itself — a group of B-cell depleting therapies that have become the most commonly initiated treatments for MS in the United States. Experts recount that the field initially viewed B-cell targeting as counterintuitive in what was long considered a T-cell-mediated disease. However, experience and trial data have demonstrated that depleting CD19/CD20-positive B cells produces profound downstream immunological effects that dramatically suppress MS disease activity.
In this episode, moderator Dr. Mitzi Joi Williams discusses Anti-CD20 Therapies in multiple sclerosis with Dr. Stephen Krieger, Dr. Benjamin Greenberg, and Dr. Riley Bove. Dr. Williams notes that while three anti-CD20 agents are FDA-approved for MS (ocrelizumab approved in 2017, followed by ofatumumab and ublituximab), rituximab has been used off-label for many years. Though these agents target the same molecule, they differ in meaningful ways.
With the first anti-CD20 therapy approved for MS now more than ten years in clinical use, in this episode titled "Long-Term Efficacy of Anti-CD20 Therapies in MS: What the Evidence Shows," Dr. Williams asks Dr. Krieger what the long-term evidence reveals about efficacy — and whether there have been any surprises.
In this episode titled "Managing Infection Risk and Safety Monitoring with Anti-CD20 MS Disease Modifying Therapy," Dr. Williams raises the issue of infection risk — a topic of increasing clinical relevance.
This episode discusses "Hypogammaglobulinemia in MS Patients on Anti-CD20 Therapy: When to Act." Dr. Williams identifies hypogammaglobulinemia — low IgG levels resulting from prolonged B-cell depletion — as one of the most clinically consequential long-term complications of anti-CD20 therapy, and asks the panel how they identify high-risk patients and manage this finding.
In this episode titled "Extended Interval Dosing of Anti-CD20 Therapies: Benefits, Risks, and Real-World Experience," moderator Dr. Mitzi Joi Williams introduces the concept of extended interval dosing (EID): rather than dosing on a fixed six-month or monthly schedule, could practitioners dose less frequently while maintaining efficacy — whether for cost, safety, or patient preference?
This episode discusses "The MS 'Wearing-Off' Phenomenon: Separating Symptom Burden from Immunological Change." Dr. Williams introduces the wearing-off phenomenon — a patient experience in which symptoms feel worse as the next anti-CD20 dose approaches. The panel explores whether this represents a true immunological change or a symptom-level phenomenon.
In this episode titled "Long-Term Management of MS: Monitoring Progression and Supporting Patient Wellness While on Anti-CD20 DMTs," Dr. Williams asks the panel what the clinical conversation looks like for patients who have been on therapy for five to seven or more years — and what new priorities have emerged.
In episode titled "Choosing Among Anti-CD20 Therapies in MS: Patient Profiles and Clinical Decision Making," Dr. Williams asks Dr. Stephen Krieger whether specific patient profiles favor one anti-CD20 agent over another among ocrelizumab, ofatumumab, and ublituximab.
In this episode titled "MS and Pregnancy: Addressing Misperceptions About Anti-CD20 Therapies and Childbearing," the panel addresses common patient misperceptions about anti-CD20 therapies. Dr. Williams begins with a topic Dr. Bove is particularly well-positioned to address: the misperception that B-cell depleting therapies are unsafe or incompatible with pregnancy.
Dr. Mitzi Joi Williams discusses "Common Misperceptions About Anti-CD20 MS Therapy: Immunosuppression, Drug Differences, and Peer Support," with MS experts.
In the final episode titled "Key Lessons Learned: Optimizing Anti-CD20 Therapy for Long-Term MS Care," each panelist reflects on the most important lesson their clinical experience with anti-CD20 therapies has taught them.
