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Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination
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Safety and efficacy of extended versus standard interval dosing of anti-CD20 therapy in multiple sclerosis - A

Mahmoud Elkhooly1, Rhea Jacob2, Torge Rempe2

  • 1Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, USA.

Multiple Sclerosis Journal - Experimental, Translational and Clinical
|March 27, 2026
PubMed
Abstract

Insights

Extended interval dosing (EID) of anti-CD20 therapy for multiple sclerosis (MS) shows comparable efficacy and safety to standard interval dosing (SID). This finding supports EID as a viable option for managing MS, potentially reducing infection risks associated with treatment.

Area of Science:

  • Neurology
  • Immunology
  • Pharmacology

Background:

  • Anti-CD20 therapy is a cornerstone treatment for multiple sclerosis (MS), effectively modifying disease progression.
  • Concerns regarding infection risks have prompted the exploration of alternative dosing strategies, such as extended interval dosing (EID).

Purpose of the Study:

  • To conduct a meta-analysis comparing the efficacy and safety of standard interval dosing (SID) versus EID of anti-CD20 therapies in people with MS (PwMS).

Main Methods:

  • A systematic literature search of PubMed and MS conference abstracts was performed.
  • Studies comparing distinct cohorts of PwMS treated with SID and EID of anti-CD20 therapy were included.
  • Meta-analysis was conducted to calculate effect sizes (log odds ratio) for efficacy and safety outcomes.

Main Results:

  • Seventeen studies involving 1739 (SID) and 1856 (EID) participants were analyzed.
  • No significant differences were observed in relapse rates, MRI activity, no evidence of disease activity (3), serious infections, or hypogammaglobulinemia G between SID and EID groups.
  • Specific log odds ratios and p-values indicated non-significant trends for all assessed outcomes.

Conclusions:

  • Current evidence from observational studies suggests that extended interval dosing (EID) of anti-CD20 therapy offers a comparable efficacy and safety profile to standard interval dosing (SID).
  • EID represents a potentially valuable alternative regimen for managing multiple sclerosis, warranting further investigation in diverse clinical settings.
Keywords:
Multiple sclerosisanti-CD20disease-modifying therapyextended interval dosing

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