Is it time for anti-CD20 discontinuation in multiple sclerosis? Cumulative risk or cumulative uncertainty
Year: 2026
Type: review
Abstract: The widespread adoption of anti-CD20 monoclonal antibodies (anti-CD20 mAbs) in multiple sclerosis (MS) has prompted increasing interest in treatment discontinuation and de-escalation strategies. In this perspective, we critically examine current data on outcomes following anti-CD20 discontinuation, including evidence from registries, prospective cohorts, and real-world studies. Available findings suggest that disease control achieved under anti-CD20 therapy is pharmacologically maintained rather than biologically resolved, and that B-cell repopulation following treatment cessation is heterogeneous and not reliably predictive of clinical stability. Reports of disease reactivation after discontinuation and the absence of validated biomarkers to identify patients who may safely stop therapy highlight substantial uncertainty. Current evidence therefore remains insufficient to support routine anti-CD20 discontinuation in MS, while a cautious, individualized approach-potentially incorporating dose-spacing strategies-may better reflect the current state of knowledge.
Source: Frontiers in Immunology
Institutions: University of Foggia, The Alfred Hospital
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223189045