Choosing Among Anti-CD20 Therapies in MS: Patient Profiles and Clinical Decision Making

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.

Dr. Krieger, while cautioning that "patient profiling" can feel more like a marketing framework than a clinical one, identifies scenarios where meaningful distinctions apply. For patients with contraindications to infusion center visits — such as those with diabetes, morbid obesity, or difficult venous access — or who have a preference for home administration, monthly subcutaneous ofatumumab offers significant advantages, including the avoidance of pre-infusion steroids and Benadryl. Patients transitioning from frequent platform injectables may find the monthly self-injection an easy improvement.

For patients who want minimal treatment touchpoints and value the "treat and forget" paradigm, biannual infusions with ocrelizumab or ublituximab may be preferable. Ublituximab has a shorter infusion time than ocrelizumab and some data suggesting marginally more thorough B-cell depletion. Ocrelizumab holds a unique distinction: it is the only anti-CD20 agent with FDA approval for primary progressive MS (PPMS), making it the data-supported choice when PPMS is the indication.

Ultimately, Dr. Krieger advises fellows that the most important signal often comes from watching the patient's face: visible relief at the prospect of biannual infusions versus evident apprehension about infusion centers and steroids each point toward different agents. Payer coverage also constrains the conversation — a practical reality that must be addressed alongside clinical preference.

In the next episode, "MS and Pregnancy: Addressing Misperceptions About Anti-CD20 Therapies and Childbearing," the panel addresses one of the most common patient concerns — and explains why this class of agents is more compatible with family planning than many patients fear.