Managing Infection Risks and Treatment De-Escalation in Patients on Long-Term Anti-CD20 Therapies in Multiple Sclerosis

Patients receiving long-term anti-CD20 disease-modifying therapies (DMTs) for Multiple SclerosisMS are at risk for infections, which is an important consideration in clinical practice. The types of infections commonly observed include respiratory tract infections, urinary tract infections, and opportunistic infections due to immune suppression. These infections can manifest at varying points during treatment, often emerging after prolonged therapy when B-cell depletion is sustained. While some infections may be mild and manageable in outpatient settings, others can lead to hospitalization, especially in patients with additional risk factors or comorbidities.

Certain patient populations are more prone to infections while on anti-CD20 therapies. Older patients, those with a history of frequent infections, and individuals with compromised immune systems due to other conditions or medications have a higher susceptibility. Monitoring and early detection are critical to managing infection risk. In clinical practice, decisions around de-escalation of therapy are often considered for patients with stable disease who also carry a high risk of infection. This strategy aims to balance disease control with minimizing treatment-related adverse events. Additionally, patients with limited disease activity but facing a high treatment burden may benefit from tailored therapy adjustments to reduce potential sideadverse effects while maintaining efficacy.

Defining disease control and stability in MS involves multiple criteria, including the absence of new disability progression, no new or enlarging lesions on MRI, and overall clinical stability. Achieving and maintaining this state is the primary goal of MS management. Regular assessments using clinical scales, imaging, and patient-reported outcomes guide treatment decisions. Ultimately, personalized care that considers infection risks, patient preferences, and disease activity is essential for optimizing long-term outcomes in patients with MS patients on anti-CD20 therapies.