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. 2025 Feb 26;11(1):20552173251315457.
doi: 10.1177/20552173251315457. eCollection 2025 Jan-Mar.

Treatment persistence and clinical outcomes in patients starting B cell depleting therapies within the Swiss MS Cohort

Giulio Disanto  1   2 , Sabine Schaedelin  3   4   5 , Johanna Oechtering  3   4 , Johannes Lorscheider  3   4 , Riccardo Galbusera  3   4   6 , Sebastian Finkener  7 , Lutz Achtnichts  7 , Patrice Lalive  8 , Stefanie Müller  9 , Caroline Pot  10 , Robert Hoepner  11 , Anke Salmen  11   12 , Chiara Zecca  1   2 , Lars G Hemkens  4   5 , Marcus D'Souza  3   4 , Bettina Fischer-Barnicol  3   4 , Renaud Du Pasquier  10 , Patrick Roth  13 , Özgür Yaldizli  3   4   6 , Maximilian Einsiedler  3   4 , Tobias Derfuss  3   4 , Ludwig Kappos  3   4 , Claudio Gobbi  1   2 , Cristina Granziera  3   4   6 , Marjolaine Uginet  8 , Aleksandra Maleska Maceski  3   4 , Keltie McDonald  14 , David Leppert  3   4 , Pascal Benkert  3   4   5 , Jens Kuhle  3   4 ; Swiss MS Cohort Study
Affiliations

Treatment persistence and clinical outcomes in patients starting B cell depleting therapies within the Swiss MS Cohort

Giulio Disanto et al. Mult Scler J Exp Transl Clin. .

Abstract

Background: Persistence to B cell depleting therapies (BCDT) like ocrelizumab and rituximab may be higher compared with other disease-modifying therapies (DMT) in multiple sclerosis (MS). Clinical trials directly comparing these treatments are lacking.

Objective: To compare the risk of treatment discontinuation, relapse, and confirmed disability worsening in patients starting BCDT vs other DMT within real-world settings.

Methods: In a longitudinal cohort study, patients with relapsing MS starting BCDT (ocrelizumab/rituximab, n = 269) after enrolment into the Swiss MS Cohort (SMSC) were evaluated for treatment discontinuation, occurrence of relapses, and disability worsening in comparison with platform (n = 57) and oral (n = 454) DMT, or natalizumab (n = 73) using Cox regression with double robust adjustment for baseline covariates.

Results: Patients starting BCDT were less likely to discontinue treatment than all other DMT combined (HR = 0.26, 95% CI = 0.18-0.36, p < .01), oral DMT (HR = 0.28, 95% CI = 0.20-0.39, p < .01) and natalizumab (HR = 0.35, 95% CI = 0.21-0.58, p < .01). BCDT were associated with lower risk of relapses as compared to oral DMT HR = 0.59, 95% CI = 0.39-0.88, p < .01), but not to natalizumab (HR = 0.90, 95% CI = 0.45-1.82, p = .778). Disability worsening was not significantly different between treatment groups.

Conclusion: We provide real-world evidence for patients being more persistent to BCDT than to other treatments, and better clinical outcomes may partly explain this.

Keywords: Multiple sclerosis; clinical outcomes; disease-modifying treatment; persistence.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curves with numbers at risk showing the proportion of patients who remained on treatment with the index DMT over the study period (BCDT in red versus oral DMT in green on the left side, and BCDT in red versus NTZ in blue on the right side). BCDT: B cell depleting therapies; DMT: disease modifying therapies; NTZ: natalizumab.
Figure 2.
Figure 2.
Kaplan-Meier curves with numbers at risk showing the proportion of patients who remained free of relapses during treatment with the index DMT over the study period (BCDT in red versus oral DMT in green on the left side, and BCDT in red versus NTZ in blue on the right side). BCDT: B cell depleting therapies; DMT: disease modifying treatments; NTZ: natalizumab.
Figure 3.
Figure 3.
Kaplan-Meier curves with numbers at risk showing the proportion of patients who remained free of 6-month CDW stratified by index DMT (BCDT in red versus oral DMT in green on the left side, and BCDT in red versus NTZ in blue on the right side). All EDSS worsening events occurred up to 4 years after termination of index DMT were considered. BCDT: B cell depleting therapies; CDW: confirmed disability worsening; DMT: disease-modifying therapies; NTZ: natalizumab.
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