Anti-CD20 monoclonal antibody therapies in relapsing multiple sclerosis: A systematic review and meta-analysis of randomised controlled trials.
Amirah Alatawi, Ahmed Salem Al-Dhahi, Abeer Alatawi et al.
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In 30 seconds
This systematic review and meta-analysis pooled 11 randomised controlled trials (N = 5911) of anti-CD20 monoclonal antibodies in relapsing multiple sclerosis, comparing them with placebo or other active treatments and including one head-to-head trial. Anti-CD20 therapy was associated with fewer clinical relapses (RR 0.48, 95% CI 0.43-0.52) and reductions in MRI lesion outcomes and EDSS worsening. Serious adverse event rates were similar between groups (RR 1.06, 95% CI 0.89-1.25). MRI outcome estimates showed substantial heterogeneity, which the authors caution may relate to trial design and comparator differences.
Key findings
- Across 11 trials, anti-CD20 therapy reduced clinical relapse risk (RR 0.48, 95% CI 0.43-0.52; I² = 24%; p < 0.001).
- Pooled estimates favoured anti-CD20 therapy for Gd+ lesions (RR 0.07, 95% CI 0.03-0.18) and new T2 lesions (RR 0.24, 95% CI 0.17-0.34), with substantial heterogeneity.
- EDSS worsening was reduced (RR 0.71, 95% CI 0.62-0.82; I² = 0%; p < 0.001).
- Serious adverse event rates were similar (RR 1.06, 95% CI 0.89-1.25; I² = 0%; p = 0.52).
Why it matters
The pooled trial evidence supports anti-CD20 monoclonal antibodies as a high-efficacy treatment class for relapsing MS, with benefits across clinical relapse and disease-activity outcomes. Similar pooled serious adverse event rates provide relevant comparative safety context. However, the marked heterogeneity in MRI outcomes means those estimates should be interpreted in light of differences in trial programmes and comparators.
What to keep in mind
MRI outcome estimates were heterogeneous, and the proposed link to trial design and comparator differences is associative rather than definitive; few trials were available per stratum.