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Review
. 2021 Aug 27:11:103-111.
doi: 10.1016/j.ibneur.2021.08.003. eCollection 2021 Dec.

The comparative efficacy and safety of anti-CD20 monoclonal antibodies for relapsing-remitting multiple sclerosis: A network meta-analysis

Mohammad Z I Asha  1 , Yousef Al-Asaad  2 , Sundos F H Khalil  3
Affiliations
Review

The comparative efficacy and safety of anti-CD20 monoclonal antibodies for relapsing-remitting multiple sclerosis: A network meta-analysis

Mohammad Z I Asha et al. IBRO Neurosci Rep. .

Abstract

With the recent successful targeting of B lymphocytes in patients with multiple sclerosis (MS), treatment with anti-CD20 monoclonal antibodies (mAbs) may represent a promising managemental approach, particularly for those with relapsing/remitting MS (RRMS). A network meta-analysis was conducted based on a comprehensive search in Embase, PubMed, and the Cochrane Library to assess the comparative efficacy and safety of currently available anti-CD20 monoclonal antibodies (mAbs), including rituximab, ocrelizumab, and ofatumumab, versus a common comparator (interferon beta-1a [INFβ-1a]) in RRMS patients recruited in randomized clinical trials (RCTs). In a frequentist network meta-analytical model, annualized relapse rates (ARRs) and safety outcomes were expressed as risk ratios (RRs), whereas relapse-free events were expressed as odds ratios (ORs). Treatment ranking was performed using P-scores. The certainty of evidence was appraised using the GRADE approach. Five publications reported the outcomes of seven RCTs (3938 patients, 67.09% females). Compared to INFβ-1a, ocrelizumab reduced the risk of ARR (RR = 0.56, 95% CI, 0.50-0.64), serious adverse events (RR = 0.17, 95% CI, 0.09-0.30), and treatment discontinuation due to adverse events (SAEs, RR = 0.60, 95% CI, 0.39-0.93), and it was associated with higher odds of no relapses (OR = 2.47, 95% CI, 2.00-3.05). Ocrelizumab ranked best among all other treatments in terms of reducing ARR and SAEs. The quality of evidence was low for ocrelizumab, low to moderate for rituximab, and high for ofatumumab. Further large-sized, well-designed RCTs are needed to corroborate the efficacy and safety of ocrelizumab and other anti-CD20 mAbs in RRMS.

Keywords: Monoclonal antibody; Multiple sclerosis; Network meta-analysis; Ocrelizumab; Relapsing-remitting multiple sclerosis.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
A PRISMA flowchart showing the search process used in the current review.
Fig. 2
Fig. 2
Network maps of eligible comparisons of the primary outcomes of efficacy (annualized relapse rate) and safety (serious adverse events). The thickness of lines represents the number of studies in each comparison.
Fig. 3
Fig. 3
Forest plots of the network meta-analysis of the efficacy and safety of anti-CD20 mAbs, including the risk of developing annualized relapse rate (A), serious adverse events (B), any adverse event (C), and discontinuation of treatments due to adverse events (D), as well as the odds of relapse-free events (E).
See this image and copyright information in PMC

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