Safety and efficacy of extended versus standard interval dosing of anti-CD20 therapy in multiple sclerosis – A meta-analysis

Background Anti-CD20 therapy is a highly effective multiple sclerosis (MS) disease-modifying therapy, but may be complicated by infections, which has led to the utilization of different extended interval dosing (EID) regimens. Objectives To compare the efficacy and safety of standard interval dosing (SID) and EID of anti-CD20 therapy in MS. Methods We searched PubMed and MS conference abstracts and included all studies comparing distinct cohorts of people with MS (PwMS) treated with SID and EID of anti-CD20 therapy that reported ≥1 efficacy or safety outcome measure. A meta-analysis was performed with effect size calculation (log odds ratio [logOR]) of efficacy and safety outcome measures. Results Seventeen studies comparing SID to EID were identified, with 1739 (SID) and 1856 (EID) participants. There was no significant difference in frequencies of PwMS with relapses (logOR = 0.15; p = 0.37), MRI activity (logOR = 0.05; p = 0.7), no evidence of disease activity −3 (logOR = 0.33; p = 0.33), serious infections (logOR = 0.46; p = 0.16), and hypogammaglobulinemia G (logOR = −0.24; p = 0.76). Conclusions Data from observational studies suggests that EID of anti-CD20 therapy may have a comparable efficacy and safety profile compared to SID.