Is it time for anti-CD20 discontinuation in multiple sclerosis? Cumulative risk or cumulative uncertainty
- 1Department of Medical and Surgical Sciences, University of Foggia
- 2Department of Neurology, The Alfred Hospital
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.
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BibTeX
@article{zanghi2026time,
title = {{Is it time for anti-CD20 discontinuation in multiple sclerosis? Cumulative risk or cumulative uncertainty}},
author = {Aurora Zanghì and Anneke van der Walt and Emanuele D’Amico},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1917676},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1917676/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Is it time for anti-CD20 discontinuation in multiple sclerosis? Cumulative risk or cumulative uncertainty
AU - Aurora Zanghì
AU - Anneke van der Walt
AU - Emanuele D’Amico
PY - 2026
DA - 2026/10/22
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1917676
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1917676/full
AB - 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.
SN - 1664-3224
ER -