Exploring the wearing-off phenomenon among anti-CD20 therapies in multiple sclerosis

The wearing-off phenomenon, characterized by the re-emergence or worsening of symptoms prior to the next scheduled dose, may affect people with Multiple Sclerosis (pwMS) receiving anti-CD20 monoclonal antibody therapies. This phenomenon can negatively influence patients' functional status and perception of disease control.

To assess the prevalence, clinical characteristics, and potential risk factors associated with the wearing-off phenomenon in pwMS treated with ocrelizumab, ofatumumab, or rituximab.

We conducted a cross-sectional cohort study involving 139 pwMS followed at a tertiary care center and undergoing treatment with anti-CD20 agents. Participants completed a structured questionnaire to identify symptoms suggestive of wearing-off.

Among the participants, 94 (67.6 %) had relapsing-remitting MS and 45 (32.4 %) had progressive forms. Patients were treated with ocrelizumab (51.8 %), ofatumumab (33.8 %), or rituximab (14.4 %). The wearing-off phenomenon was reported by 43 patients (30.9 %), most commonly presenting with fatigue (86.0 %) and balance disturbances (37.2 %). Symptom onset occurred more than one week before infusion in 67.4 % of cases, with delayed resolution (>7 days post-infusion) in 46.5 %. Most classified symptoms as moderate to severe, with notable functional impact and increased anxiety in 65.1 %. No significant differences in prevalence were observed among the three drugs. Wearing-off was more frequent in females (p = 0.046). Among males, higher body weight and body surface area were initially associated with the phenomenon but did not remain significant in multivariate models. No associations were found with BMI, age, EDSS, or treatment duration.

Wearing-off is frequently reported across anti-CD20 therapies, though its subjective nature and lack of biomarkers present challenges for targeted management strategies.