Extended Interval Dosing of Anti-CD20 Therapies: Balancing Efficacy and Safety

Extended interval dosing (EID)EID of anti-CD20 therapies, such as ocrelizumab, has emerged as a promising strategy to reduce cumulative immunosuppression and potentially lower the risk of infections in patients with Multiple SclerosisMS. Real-world data suggest that extending dosing intervals from the standard 6 months to 7 to –9 months can maintain effective disease control while minimizing adverse events. This approach is based on the understanding that B-cell depletion often persists beyond the typical dosing schedule, allowing for sustained therapeutic effects even with less frequent administration.

Regarding the impact of EID on safety outcomes, the evidence remains somewhat preliminary but encouraging. While the biological rationale supports the idea that less frequent dosing may reduce infection risk and other immunosuppressive complications, definitive proof of improved safety remains to be established in large prospective trials. In clinical practice, many neurologists have begun adopting EID cautiously, especially in patients who have demonstrated stable disease and are at higher risk for infections. This approach balances the need for continued disease suppression with the goal of minimizing treatment-related harm, though ongoing monitoring is essential to detect any resurgence of disease activity.

Clinicians’ impressions of EID have generally been positive, with many reporting successful maintenance of disease control alongside a perceived reduction in infection rates or other adverse effects. However, patient selection is critical, with those who have stable MRI and clinical outcomes being the best candidates for this strategy. Overall, EID represents a practical de-escalation option that aligns with personalized medicine principles, tailoring treatment intensity based on individual risk profiles and disease activity.