There are five different anti-CD20 used in MS (rituximab-Off label), divozilimab (Russia), ublituximab, ocrelizumab, ofatumumab which bind to 4 different and 3 more markedly different targets on CD20, so if you fail one you can switch to another. The current most common is ocrelizumab and ofatumumab. Ocrelizumab is often intravenous 6 monthly comapred to under the skin ofatumumab monthly. This appears efficacious and safe to do a switch. The neuros may switch because of availability of infusion chairs and give you home delivery. You can now get ocrelizumab under the skin at 6 monthly doses. If you develop antibdrug antibodies as a reason for failing divolizumab then a switch to rituximab could be problematic, and if you switch to ocrelizumab so anti-drug antibodies may cross react. BUt you have choice of different CD20 targets and different mechanism of action. That means a switch is feasible following discussion with you neuro
Hua LH, Brown B, Camacho E, Chinea AR, Greenberg BM, Henry RG, Houtsma E, Moreo N, Alvarez E. Switch from intravenous anti-CD20 therapy to subcutaneous ofatumumab in patients with relapsing MS: results from the OLIKOS study. J Neurol. 2025 Oct 24;272(11):725.
Background: Multiple sclerosis (MS) is a chronic condition, and as such, switching therapies is not uncommon. However, data on switching from intravenous (IV) to subcutaneous (SC) formulations of anti-CD20 therapies are lacking.
Methods: OLIKOS, a phase 3b, prospective, single-arm, multicenter study conducted from 2020 to 2024, evaluated the efficacy and safety of switching to SC ofatumumab from IV ocrelizumab or rituximab in adults with relapsing MS. Participants were excluded if they had discontinued anti-CD20 therapy due to suboptimal response or safety concerns. Maintenance of efficacy was defined as either no change or a reduction from baseline in the number of gadolinium-enhancing (Gd +) T1 lesions observed by magnetic resonance imaging (MRI) after 12 months of ofatumumab.
Results: The full analysis set included 102 participants. Most participants (99%) switched from IV ocrelizumab to SC ofatumumab. Zero Gd+ T1 lesions were observed at Month 12 in participants with evaluable MRI assessments (n = 84), satisfying the primary endpoint. New/enlarging T2 lesions were observed in 2.3% (2/86) of participants at Month 12. There was no change in median Expanded Disability Status Scale score between baseline and Month 12, and annualized relapse rate remained low (0.075). Treatment satisfaction improved from baseline to Month 12 across all domains with the largest increases in the Convenience domain. Treatment-emergent adverse events occurred at similar frequencies as in ofatumumab phase 3 trials, and no new safety signals were identified.
Conclusion: The findings indicate efficacy and safety are maintained following a switch from IV anti-CD20 to SC ofatumumab with improved treatment satisfaction.
COI: Multiple
Disclaimer MY views alone
Source: multiple-sclerosis-research.org