Comparing Anti-CD20 Therapies in MS

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.

Dr. Greenberg explains that the anti-CD20 agents differ in molecular design, B-cell killing mechanism, and dosing schedules. The practical framework he uses with patients begins with administration mode: biannual IV infusion (ocrelizumab, ublituximab), biannual subcutaneous injection (ofatumumab at the higher dose), or monthly self-administered injection (ofatumumab). For patients without infusion center access, self-injection is often the default; for others, infusion center experience and time burden may be the deciding factors.

Beyond logistics, there are clinical distinctions: ublituximab has a shorter infusion time than ocrelizumab; infusion-related reaction profiles differ across agents; duration of clinical experience varies. Dr. Greenberg acknowledges the challenge of presenting information neutrally — clinician framing inevitably influences patient choice.

On rituximab, Dr. Greenberg and Dr. Williams note that while it remains widely used in some health systems and may be the only accessible option in certain settings, FDA-approved agents are preferred when access permits. The panel anticipates that future data may reveal more granular efficacy differences between agents within the class, though the high overall efficacy makes such differences difficult to detect at a population level.

In the next episode, "Long-Term Efficacy of Anti-CD20 Therapies in MS: What the Evidence Shows," the panel reviews what a decade of real-world experience and long-term extension data tell us about sustained B-cell depletion.