B-Cell–Depleting Therapy Linked to Fewer Relapses in Early MS

B-cell–depleting therapies (BCDTs) were associated with lower relapse incidence and greater reductions in T2 lesion volume over 2 years than oral platform therapies among treatment-naïve adults with newly diagnosed multiple sclerosis (MS). The findings came from a prospective observational cohort study conducted in Europe and published in Neurology Open Access.

The MultipleMS study enrolled 509 adults aged 18 to 50 years at 9 centers from September 2017 through December 2020. Sites were located in 7 European countries, and 455 participants (89.4%) completed follow-up. Initial treatment groups were injectable platform therapies (n = 87), oral platform therapies (n = 152), high-efficacy therapies (n = 79), BCDTs (n = 101), and no treatment (n = 90).

The primary outcomes were annualized relapse rate through month 24, change in T2 lesion volume from baseline to month 24, and serum neurofilament light chain (sNfL) Z-score at month 24. Analyses followed an intention-to-treat approach and adjusted for demographic variables, baseline disease characteristics, and country.

Compared with oral platform therapies, BCDTs were associated with lower relapse incidence (incidence rate ratio, 0.38; 95% CI, 0.15–0.92). BCDTs were also associated with greater T2 lesion volume reduction (volume ratio, 0.87; 95% CI, 0.76–0.99). Changes in Expanded Disability Status Scale scores and sNfL did not differ among groups. Treatment persistence at month 24 was 93.8% with BCDTs versus 72.3% with oral platform therapies. In an analysis restricted to treatment-persistent participants, the relapse association was no longer evident, whereas the T2 lesion volume finding persisted at borderline statistical significance.

The authors said BCDTs and high-efficacy therapies appeared to have greater effects on acute inflammatory outcomes than progression-related outcomes. They noted the observational, nonrandomized design and possible residual confounding as limitations. The 2-year follow-up and missing data, particularly for MRI measures and partly related to COVID-19 disruptions, were additional limitations.

Source: Uibel P, Trogu F, Flaskamp M, et al. Therapy choices and outcomes in newly diagnosed multiple sclerosis: the Pan-European MultipleMS study. Neurol Open Access. 2026;2:e000168. doi:10.1212/WN9.0000000000000168