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Published on: December 9, 2015
Disease Course After Anti-CD20 Discontinuation in Secondary Progressive Multiple Sclerosis-A Multicenter Long-Term
Ferdinand Otto1,2, Dariia Kliushnikova1, Richard Friedrich Radlberger1
1Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.
Annals of Clinical and Translational Neurology
|July 29, 2026
Summary
Long-term outcomes in secondary progressive multiple sclerosis (SPMS) patients discontinuing anti-CD20 therapy showed accumulating disability worsening. Focal inflammatory activity was rare, but disability progression occurred over time in this untreated cohort.
Area of Science:
- Neurology
- Immunology
- Clinical Trials
Background:
- Anti-CD20 therapies are used for multiple sclerosis (MS).
- Long-term outcomes after discontinuing anti-CD20 therapy in secondary progressive multiple sclerosis (SPMS) without subsequent disease-modifying therapy (DMT) are not well-defined.
- Understanding outcomes in SPMS patients after anti-CD20 discontinuation is crucial for treatment management.
Purpose of the Study:
- To describe the long-term clinical outcomes in a selected cohort of SPMS patients after anti-CD20 discontinuation.
- To evaluate disability progression, relapses, and MRI activity in SPMS patients who did not receive further DMT.
- To generate hypotheses regarding the long-term effects of anti-CD20 cessation in SPMS.
Main Methods:
- Retrospective analysis of data from four centers in Austria and Switzerland.
- Inclusion criteria: SPMS, at least two anti-CD20 cycles, discontinuation without subsequent DMT, and at least 36 months of follow-up.
- Primary endpoint: time to first confirmed Expanded Disability Status Scale (EDSS) worsening (≥0.5-point increase). Secondary endpoints: relapses, MRI activity, and severe infections.
Main Results:
- Fifty-five SPMS patients were included, with a mean follow-up of 55.1 months post-discontinuation.
- Confirmed EDSS worsening occurred in 56% of patients, with a mean EDSS increase from 6.3 at discontinuation to 6.9 at last follow-up.
- Focal inflammatory activity (relapses, MRI) was uncommon (10.9% and 11%, respectively), but severe infections occurred in 31% of patients.
Conclusions:
- In this selected SPMS cohort, anti-CD20 discontinuation was associated with accumulating disability worsening over the long term, despite infrequent focal inflammatory activity.
- Early disease activity might have been underestimated due to the inclusion criteria requiring extended untreated follow-up.
- These findings are descriptive and hypothesis-generating, not establishing safety or optimal timing for anti-CD20 discontinuation.
