Anti-CD20 Discontinuation Versus Continuation in People Aged Over 50 With Non-Active Multiple Sclerosis

Area of Science:

• Neurology
• Immunology
• Clinical Research

Background:

• Anti-CD20 therapies are effective for relapsing-onset multiple sclerosis (MS).
• Discontinuation strategies for older MS patients with stable disease are under investigation.
• Long-term safety and efficacy data for stopping anti-CD20 therapy in this demographic are limited.

Purpose of the Study:

• To evaluate the risk of relapse, inflammatory activity, disability progression, and serious infections after discontinuing anti-CD20 therapy in patients with relapsing-onset MS aged over 50.
• To compare outcomes between patients who discontinued anti-CD20 therapy and those who continued.

Main Methods:

• Retrospective, multicenter cohort study of 2283 MS patients aged >50 from the French MS registry.
• Inclusion criteria: received ≥2 anti-CD20 cycles, no relapse/MRI activity for ≥1 year.
• 1:1 propensity score matching was used to compare patients discontinuing vs. continuing anti-CD20 therapy.

Main Results:

• Matched cohort: 224 patients in each group (discontinuing vs. continuing therapy).
• No significant differences observed in time to first relapse (HR=0.6), inflammatory activity (HR=0.9), confirmed disability accrual (HR=1.2), or serious infections (HR=1.0).
• Median follow-up after matching was 34.8 months.

Conclusions:

• Discontinuing anti-CD20 therapy in older patients (>50) with long-standing, non-active MS is not associated with an increased risk of clinical or radiological disease activity.
• No significant difference in serious infection rates was found between groups.
• Findings suggest that stopping anti-CD20 therapy may be a safe option for select older MS patients with stable disease.