Safety and efficacy of anti-CD20 monoclonal antibodies versus teriflunomide in relapsing multiple sclerosis: a systematic review and meta-analysis.
Hafiz Muhammad Haris, Hafiz Asad Ullah, Gul Sher Ghouri et al.
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In 30 seconds
This systematic review and meta-analysis compared anti-CD20 monoclonal antibodies with teriflunomide in adults with relapsing multiple sclerosis. Six trials from four studies were reviewed, with five trials contributing to quantitative synthesis. Anti-CD20 therapies were associated with a lower annualized relapse rate than teriflunomide (rate ratio [RR] = 0.45, 95% CI [0.38, 0.53]; p < 0.00001) and fewer MRI lesions. Overall adverse events and infections were comparable, while serious adverse events were increased with anti-CD20 therapies. No significant difference was found in brain volume change, and evidence on disability progression was inconsistent.
Key findings
- Annualized relapse rate was lower with anti-CD20 therapies than teriflunomide (RR = 0.45, 95% CI [0.38, 0.53]; p < 0.00001).
- Anti-CD20 therapies reduced gadolinium-enhancing T1 lesions (MD = - 0.41, 95% CI - 0.52 to - 0.30) and new or enlarging T2 lesions (MD = - 3.05, 95% CI - 3.52 to - 2.58).
- Serious adverse events were increased with anti-CD20 therapies (RR = 1.27, 95% CI 1.01 to 1.61); overall adverse events and infections were comparable.
- There was no significant difference in brain volume change, and findings on disability progression were inconsistent.
Why it matters
The comparison highlights a trade-off relevant to disease-modifying therapy selection: anti-CD20 therapies showed stronger control of relapses and MRI activity, but serious adverse events were more frequent. The absence of a clear brain-volume advantage and inconsistent disability findings mean that benefits across disease outcomes are not uniform. These results help frame efficacy and safety considerations without establishing superiority on every clinically important outcome.
What to keep in mind
The quantitative synthesis included five trials, and the abstract reports inconsistent findings for disability progression. The authors call for large-scale randomised trials and long-term safety monitoring.