Early Use and Duration of B-Cell Therapies in Multiple Sclerosis

B-cell–directed therapies and other high-efficacy disease-modifying treatments (DMTs) have shown significant advantages in managing Multiple Sclerosis by reducing relapse rates and MRI activity more effectively than traditional platform therapies. These treatments have transformed the MS landscape, offering patients options that can better control disease progression and improve long-term outcomes. Positioning these high-efficacy therapies early in the disease course is becoming increasingly common, as it may prevent irreversible neurological damage and enhance quality of life. However, treatment decisions must balance potential benefits against risks such as infection, immune suppression, and other side effects.

Initiating patients on high-efficacy or B-cell therapies early has the advantage of more aggressive disease control, which may reduce the accumulation of disability. Early use can help patients maintain functionality and independence over time, potentially delaying or preventing disease progression. On the downside, these therapies can pose safety concerns, require closer monitoring, and may have higher upfront costs. Patient preferences, comorbidities, and lifestyle factors also influence the decision to start high-efficacy therapies early. A personalized approach that weighs these factors is essential to optimize patient outcomes.

Regarding treatment duration, patients often remain on anti-CD20 DMTs for extended periods, sometimes years, as long as the therapy continues to effectively control disease activity without unacceptable side effects. The decision to continue or discontinue treatment involves regular assessment of disease status, patient tolerance, and emerging evidence on long-term safety and efficacy. As the MS treatment landscape evolves, ongoing research and clinical experience will further clarify optimal timing and duration for these powerful therapies.