{"id":2127,"date":"2026-06-01T08:24:58","date_gmt":"2026-06-01T08:24:58","guid":{"rendered":"https:\/\/wickedsister.evit.com.au\/index.php\/2026\/06\/01\/anti-cd20-antibodies-know-one-know-them-all\/"},"modified":"2026-06-01T08:24:58","modified_gmt":"2026-06-01T08:24:58","slug":"anti-cd20-antibodies-know-one-know-them-all","status":"publish","type":"post","link":"https:\/\/wickedsister.evit.com.au\/index.php\/2026\/06\/01\/anti-cd20-antibodies-know-one-know-them-all\/","title":{"rendered":"Anti-CD20 antibodies. Know One, Know them All?"},"content":{"rendered":"
Tweet<\/a><\/div>\n

This is a question I have posed and answered. Are they the same? You know that you can have them as an infusion or at home and they inhibit relapses and new lesion formation and this class of drug has become one of the most used drugs in MS<\/p>\n

There are currently three antibodies approved for use in multiple sclerosis in the UK…… There is ocrelizumab, then came ofatumumab and then came ublituximab. In some countries r(natably rituxiland) rituximab is used off-label. The question is are they the same? The answer is yes and no. They all are dosed to keep the level of circulating CD20 B cells at a low level and so they inhibit relapses and new lesion formation. <\/p>\n

However, how this is achieved is different. <\/p>\n

Ocrelizumab and ublituximab and rituximab are dosed every 6 months (24 weeks) and ofatumumab is dosed every month (4 weeks) so enough is given to keep the B cells depleted in the circulation for a month or 6 months. For the antibodies about a half of it disappears each month so that is why you give a higher dose if you are treating every 6 months.<\/p>\n

Ofatumumab and ocrelizumab are or can be given as an injection under the skin. In early trials ofatumumab was given as an infusion every six months. So we know alot about them.<\/p>\n

The maximum levels of antibody reaching the blood are very different and are about a hundred times less with ofatumumab compared to ocrelizumab and ublituximab in MS. This could impact biology.<\/p>\n

The antibodies kill the B cells in different ways. This can impact biology.<\/p>\n

There are many more anti-CD20 antibodies than the ones used in MS, many of them are approved for use in cancer<\/p>\n

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Tositumomab is a mouse antibody that was linked to radioactivity to kill B cell cancers. Obinutuzumab and rituximab are approved for use in cancer as was ofatumumab. This is why they have “tu” in the name<\/p>\n

Divozilimab is approved for MS in Russia…this , it turns out is a humanised variant of rituximab. Tositumomab, zuberitamab and orcelizumab should bind to the same target. A variant of obinutuzumab, which can shuttle into the CNS better is being developed for potential use in MS.<\/p>\n

They all bind to CD20 can bind in different ways (Below is a schematic you find in reviews….It is not correct) <\/p>\n

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Today this is a German Real-Word Study <\/p>\n

St\u00f6gbauer J, Bewarder M, Gro\u00df L, Thurner L, Fassbender K, Urschel R, H\u00f8gest\u00f8l EA, Nygaard GO, Harbo HF, St\u00fcve O, Pawlitzki M, Meuth SG, Sester M, Groppa S, Fousse M. Real-world comparison of anti-CD20 therapies: efficacy, infections, and immune profiles in a German cohort. Front Immunol. 2026 May 12;17:1738865.<\/p>\n

Background:\u00a0<\/strong>The use of anti-CD20 drugs has become a widespread therapeutic approach in systemic and central nervous system (CNS) neuroinflammation. Apart from the desired B-cell depletion, relevant dynamics of the humoral and cellular immune response occur. Despite the extensive utilization of these drugs, direct comparative analyses of various B-cell-depleting agents remain scarce.<\/p>\n

Methods:\u00a0<\/strong>A total of 262 patients with neuroimmunological diseases treated with ocrelizumab<\/strong>, ofatumumab<\/strong>, or rituximab<\/strong> were observed over a median period of 36 months. Relapses, infection rates, and the concentration of immunoglobulins were monitored quarterly. In addition, changes in cellular immunity (differential blood count, natural killer cells, CD19+<\/sup>, CD3+<\/sup>, CD4+<\/sup>, and CD8+<\/sup>\u00a0cells) along with polyclonal T-cell function (measured by reactivity) were analyzed using multidimensional flow cytometry.<\/p>\n

Results:\u00a0Annual relapse rates in both the ocrelizumab and ofatumumab groups were low<\/strong>: 0.11 [95 % confidence interval (CI), 0.06 – 0.15] and 0.08 (95% CI, 0.05 – 0.16), respectively (They both work<\/em>). Infections occurred significantly less frequently with ofatumumab (p < 0.001) (Fewer infections occur suggests that ofatumumab is not as depleting as the other antibodies<\/em>). Hypogammaglobulinemia was observed more frequently and earlier in rituximab patients (p < 0.001). (There was less reduction of IgG with ofatumumab than ocrelizumab but the difference was not statistically different<\/em>). Ocrelizumab treatment was associated with a reduction in the proportion of total lymphocytes and an increase in the proportion of CD3+<\/sup>\u00a0T cells, while ofatumumab was linked to a rise in the CD4\/CD8 ratio. Anti-CD20 antibodies did not influence T-cell reactivity after polyclonal stimulation.<\/p>\n

Conclusions: <\/strong>B-cell depletion is effective in neuroimmunological diseases irrespective of which CD20 antibody was used. However, differences in infection rates and the occurrence of hypogammaglobulinemia were observed. Together with new insights into differences in the influence of CD20 antibodies on lymphocyte subpopulations, these findings may inform future individualized treatment strategies.<\/p>\n

COI: Multiple<\/p>\n

Disclaimer. My views and my figures<\/p>\n

Source: multiple-sclerosis-research.org<\/a><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Tweet This is a question I have posed and answered. Are they the same? You know that you can have them as an infusion or at home and they inhibit relapses and new lesion formation and this class of drug has become one of the…<\/p>\n","protected":false},"author":0,"featured_media":2128,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[11,15,9,8,13,14,12,10],"class_list":["post-2127","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-multiple-sclerosis-research","tag-brain-repair","tag-marburg-type-ms","tag-ms","tag-multiple-sclerosis","tag-myelin","tag-neuroregeneration","tag-oligodendrocyte","tag-remyelination"],"_links":{"self":[{"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/posts\/2127","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/comments?post=2127"}],"version-history":[{"count":0,"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/posts\/2127\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/media\/2128"}],"wp:attachment":[{"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/media?parent=2127"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/categories?post=2127"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wickedsister.evit.com.au\/index.php\/wp-json\/wp\/v2\/tags?post=2127"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}