With the recent successful targeting of B lymphocytes in patients with
multiple sclerosis (MS), treatment with anti-CD20
monoclonal antibodies (mAbs) may represent a promising managemental approach, particularly for those with relapsing/remitting MS (RRMS). A network meta-analysis was conducted based on a comprehensive search in Embase, PubMed, and the Cochrane Library to assess the comparative efficacy and safety of currently available anti-CD20
monoclonal antibodies (mAbs), including
rituximab,
ocrelizumab, and
ofatumumab, versus a common comparator (
interferon beta-1a [INFβ-1a]) in RRMS patients recruited in randomized clinical trials (RCTs). In a frequentist network meta-analytical model, annualized relapse rates (ARRs) and safety outcomes were expressed as risk ratios (RRs), whereas relapse-free events were expressed as odds ratios (
ORs). Treatment ranking was performed using P-scores. The certainty of evidence was appraised using the GRADE approach. Five publications reported the outcomes of seven RCTs (3938 patients, 67.09% females). Compared to INFβ-1a,
ocrelizumab reduced the risk of ARR (RR = 0.56, 95% CI, 0.50-0.64), serious adverse events (RR = 0.17, 95% CI, 0.09-0.30), and treatment discontinuation due to adverse events (SAEs, RR = 0.60, 95% CI, 0.39-0.93), and it was associated with higher odds of no relapses (OR = 2.47, 95% CI, 2.00-3.05).
Ocrelizumab ranked best among all other treatments in terms of reducing ARR and SAEs. The quality of evidence was low for
ocrelizumab, low to moderate for
rituximab, and high for
ofatumumab. Further large-sized, well-designed RCTs are needed to corroborate the efficacy and safety of
ocrelizumab and other anti-CD20 mAbs in RRMS.