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B-cell depletion therapy is a category of disease-modifying therapies (DMTs) that’s changed the way many people manage multiple sclerosis (MS). These medications are among the most effective multiple sclerosis treatments available today.
B-cell depletion therapies work differently than many older DMTs by targeting a specific type of immune cell involved in MS attacks. Over the past several years, B-cell depletion therapies have become a common treatment choice because they can provide powerful disease control with relatively infrequent dosing.
In this article, we’ll explain what B-cell depletion therapy is, how these medications work in MS, and how effective they are. We’ll also list which B-cell depletion drugs are available, along with their potential side effects.
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B-cell depletion therapy is a type of MS immune therapy that targets certain B cells. B cells are a type of white blood cell that’s part of your immune system. B cells produce antibodies, immune proteins that fight infections and recognize infections the body has seen before.
B cells usually help protect the body. But in people with MS, some B cells malfunction and contribute to immune attacks on the central nervous system (brain and spinal cord).
Researchers now know that B cells do more than make antibodies. They can also activate other immune cells and release inflammatory signals that help drive MS disease activity.
That’s one reason researchers have become so interested in B cells over the past several years. By targeting these cells, it’s possible to interrupt several parts of the immune response involved in MS. This helps reduce inflammation and lower the risk of future relapses.
B-cell therapies are made from laboratory-created antibodies called monoclonal antibodies. Each monoclonal antibody is designed to recognize a protein called CD20 that’s found on the surface of certain B cells.
Once the medication attaches to those B cells, your immune system removes them from circulation. With fewer of these B cells available, the immune system is less likely to trigger the inflammation that causes relapses and new MS lesions.
It’s important to know that these medications don’t suppress your entire immune system.
There are currently three U.S. Food and Drug Administration (FDA)-approved B-cell depleting therapies for multiple sclerosis. They all work in a similar way, by targeting certain B cells. But they differ in how they’re administered and which types of MS they’re approved to treat.
Approved in 2017, ocrelizumab was the first B-cell depleting therapy available for MS. It’s given as an intravenous (IV) infusion or subcutaneous (under-the-skin) injection. After the initial starting doses, most people receive an infusion every six months. Ocrelizumab is approved for relapsing forms of MS as well as primary progressive multiple sclerosis (PPMS).
Ofatumumab was approved in 2020 and offers a different option for people who prefer not to receive infusions. It’s given as a once-monthly injection under the skin that most people can administer at home after the initial loading doses. Ofatumumab is approved for relapsing forms of MS.
Approved in 2022, ublituximab is another IV infusion therapy. After the initial doses, it’s typically given every six months. Ublituximab is approved for relapsing forms of MS.
You may have read about rituximab while researching B-cell therapies for MS. Although it isn’t FDA-approved to treat multiple sclerosis, some neurologists prescribe it off-label, meaning it’s indicated for other conditions than MS.
Like the approved B-cell therapies, rituximab targets CD20-positive B cells and has been shown in clinical trials to reduce MS disease activity. If your neurologist recommends rituximab, they can explain why it may be an appropriate option for your individual situation.
B-cell therapies are considered some of the most effective DMTs available for relapsing forms of MS. As a group, they’ve consistently been shown to:
Ocrelizumab has also been shown to slow disability progression in people with PPMS, making it the first medication approved for that form of the disease.
While no treatment can stop MS completely, B-cell therapies have become a common choice for people looking for a highly effective option to help keep the disease under control.
Studies comparing different MS treatments have consistently found that B-cell therapies rank among the highest-performing DMTs for reducing relapses and new MRI activity. While everyone’s experience is different, many people remain clinically stable for years with appropriate treatment and regular follow-up.
Like all medications, B-cell therapies can cause side effects. Fortunately, many people tolerate them well. Some of the more common side effects include:
If you’re receiving an infusion, your healthcare team may give you medications beforehand to reduce the chance of an infusion reaction.
Because these medications reduce part of the immune system, they can increase your risk of certain infections. Most infections are mild and treatable. These can include:
Serious infections are less common, but they can happen.
These medications can reactivate some viruses that have been inactive in the body. Before starting treatment, your neurologist will usually screen you for infections such as hepatitis B.
If you stay on treatment for several years, your healthcare team may also monitor your immunoglobulin levels. Immunoglobulins are antibodies that help your body fight infections. Lower levels may increase your risk of getting sick.
You’ll also have routine blood work while you’re on treatment. These regular checkups help your neurologist monitor how you’re responding to therapy and identify any potential issues early.
It’s also a good idea to talk with your healthcare provider about vaccines before starting treatment. Since B-cell therapies can make some vaccines less effective, timing them before treatment begins or between doses may provide better protection.
B-cell therapies are often recommended for people with relapsing forms of MS and, in the case of ocrelizumab, primary progressive MS.
The best treatment depends on many factors, including:
Every MS journey is different, so there’s no single best treatment for everyone. What works well for one person may not be the right fit for another.
If you’re interested in learning more about your options, talk with your neurologist. They can help you compare the benefits and risks of different multiple sclerosis treatments and decide which one best fits your goals.
On MyMSTeam, people share their experiences with multiple sclerosis, get advice, and find support from others who understand.
Have you used B-cell therapy to manage your MS? Let others know in the comments below.
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