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Quantifying the Impact of Ocrelizumab on Paramagnetic Rim Lesions in Multiple Sclerosis

Kimberly H Markowitz1, Neha V Safi1, Iliana Pliska-Bloch1

  • 1Department of Neurology, Weill Cornell Medicine, New York, New York, USA.

Annals of Clinical and Translational Neurology
|March 10, 2026
PubMed

Insights

Ocrelizumab treatment reduced iron levels in paramagnetic rim lesions (PRLs) in multiple sclerosis (MS) patients. This suggests the B-cell therapy may decrease iron-related inflammation in these chronic active MS lesions.

Area of Science:

  • Neuroimmunology
  • Radiology
  • Pharmacology

Background:

  • Paramagnetic rim lesions (PRLs) are key indicators of chronic active multiple sclerosis (MS).
  • These lesions are characterized by iron-rich microglia and macrophages.
  • The impact of ocrelizumab, a CD20+ B-cell depleting therapy, on PRLs is not well understood.

Purpose of the Study:

  • To investigate the effect of ocrelizumab on paramagnetic rim lesions (PRLs) in multiple sclerosis (MS).
  • To assess changes in iron content within PRLs following ocrelizumab treatment using quantitative susceptibility mapping (QSM).

Main Methods:

  • Longitudinal study of 29 ocrelizumab-treated MS patients with at least one PRL.
  • Quantitative susceptibility mapping (QSM) was used to measure iron content in 97 identified PRLs.
  • Comparison of QSM values in PRLs before and after ocrelizumab treatment.

Main Results:

  • Pre-treatment PRLs exhibited significantly higher QSM values compared to non-PRLs (p=0.001), confirming iron enrichment.
  • Ocrelizumab treatment led to a significant reduction in QSM values in PRLs (p<0.001).
  • An accelerated decline in magnetic susceptibility was observed in PRLs post-treatment.

Conclusions:

  • Ocrelizumab treatment significantly reduces iron deposition in paramagnetic rim lesions (PRLs).
  • These findings suggest that ocrelizumab may mitigate iron-related inflammation associated with chronic active MS lesions.
  • Ocrelizumab demonstrates a potential therapeutic effect on the inflammatory processes within established MS lesions.
Keywords:
multiple sclerosisocrelizumabquantitative susceptibility mapping

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