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Comparable Infection Risk of Ocrelizumab and Rituximab in Multiple Sclerosis in a Nationwide Swedish Cohort Study
Thomas Frisell1, Sebastian Hedberg1, Fredrik Piehl2,3
1Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Annals of Neurology
|June 18, 2026
Summary
In multiple sclerosis (MS), anti-CD20 therapies like rituximab and ocrelizumab increase infection risk but effectively lower relapse rates. The infection and relapse risks were found to be similar between rituximab and ocrelizumab treatments.
Area of Science:
- Neurology
- Immunology
- Pharmacology
Background:
- Anti-CD20 therapies are crucial for managing multiple sclerosis (MS).
- These therapies, including rituximab and ocrelizumab, are linked to an elevated risk of infections.
- Comparative infection risk between rituximab and ocrelizumab in MS is not well-established.
Purpose of the Study:
- To compare the infection risk and relapse outcomes between rituximab and ocrelizumab in a large nationwide multiple sclerosis cohort.
- To evaluate the safety and efficacy profiles of these specific anti-CD20 agents.
Main Methods:
- A nationwide cohort study analyzed 16,872 treatment episodes from 2014 to 2025.
- Included treatments were rituximab, ocrelizumab, and other disease-modifying therapies (DMTs).
- Infection outcomes (serious infections, hospital diagnoses, antibiotic use) and relapse risk were assessed.
Main Results:
- Both rituximab and ocrelizumab were associated with increased infection rates compared to other DMTs.
- Relapse rates were significantly lower for both rituximab and ocrelizumab.
- No significant difference in infection or relapse risk was observed between rituximab and ocrelizumab.
Conclusions:
- Rituximab and ocrelizumab demonstrate similar safety and efficacy profiles regarding infection risk and relapse prevention in MS.
- Both agents offer substantial relapse reduction but require monitoring for increased infection risk.
- Findings support informed clinical decision-making for anti-CD20 therapy selection in MS.
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