AAN 2026 | Guidance for switching away from anti-CD20 therapies in the treatment of multiple sclerosis

So we know that anti-CD20 therapies are very reliable, high efficacy, disease-modifying therapies. And of course, there will be situations when the switch within the DMC will have to occur. And one of those scenarios could be if the patient is experiencing infections and that could be on the background of a lowered level of the immunoglobulins. And that may prove to be rather not necessarily very safe for the patient to go on like this. And this could be a good scenario to consider the potential switch within the different options that we have. And that would be a potential scenario where we may consider a different mechanism of action for the patient. So whenever we need to switch from anti-CD20 therapy, we actually need to explain to the patient that there will be a period of transition and the expectations should be set correctly. So there might be a different experience with different therapies. And I think that it’s important so that the patients would be prepared. So my experience has been that actually it is relatively easy, and we should not be afraid of trying different things, because continuous use of anti-CD20 can be very effective and safe for some patients, but may not be so for some other patients. I have good experience of switching from anti-CD20s to the S1P modulators, and I think that was very good, reliable, and proved to be satisfactory. I also have good experience of switching to natalizumab. And patients, especially those patients who really rely on the anti-CD20s for the high efficacy, so those patients, if properly instructed and properly consulted in terms of the safety and need for close monitoring, we can consider switching to natalizumab. I also had good experience of switching from anti-CD20s to cladribine as well. Of course, again, with close monitoring and clear understanding of all the needs for clinical and laboratory MRI follow-ups. And I also had good experience switching from anti-CD20s to fumarates to teriflunomide. So the options are really quite different, quite diverse. And it really depends on who the patient is and what is the patient’s demographics, the background, the comorbid conditions. So if we consider all of the above, then I think that we can be very successful. Good news says that we have such a great spectrum of different mechanisms of action, and this is why patients can really be quite successful in selecting. Sometimes we have to explain to the patients that it may not be necessarily the very first therapy that we switch to to prove to be the best one. We might actually go to the next one, but that’s not a failure. It’s just our attempt to find the best fit. And this is when the patient needs to understand that we need to work very closely together with them as specialists for this reason.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.