Authors
Julia Feige, Larissa Hauer, Johann Sellner
Published in
Expert review of clinical immunology. Pages 1-19. Sep 15, 2026. Epub Sep 15, 2026.
Abstract
Multiple sclerosis (MS) is a leading cause of neurological disability in young adults, necessitating early high-efficacy disease-modifying therapies (DMTs). Monoclonal antibodies targeting the CD20 antigen are a cornerstone of effective disease control, but depletion of peripheral B-cells blunts the humoral immune response. This review synthesizes current evidence on COVID-19 risk, prevention and treatment in anti-CD20-treated people with multiple sclerosis (pwMS).
A PubMed literature search through June 2026 identified relevant studies on anti-CD20 therapies and COVID-19 in pwMS. While MS itself does not increase COVID-19 susceptibility, anti-CD20-induced immunosuppression predisposes patients to severe COVID-19 outcomes and protracted or relapsing infections. Furthermore, B-cell depletion severely impairs vaccine efficacy, leaving patients with markedly diminished or absent neutralizing antibody responses.
To mitigate COVID-19 risks, future strategies should focus on three pillars. First, strategic switching among anti-CD20 antibodies to improve vaccine efficacy. Second, variant-targeted monoclonal antibodies for pre- and post-exposure prophylaxis in patients lacking robust humoral responses. Finally, early administration of direct-acting small-molecule antivirals to halt viral replication before hyperinflammation. Moving forward, integrating real-world data, identifying immunogenetic risk biomarkers, and evaluating long-term combinations of vaccine-passive immunizations will help safely sustain high-efficacy MS treatments.
PMID:
42741870
Bibliographic data and abstract were imported from PubMed on 15 Sep 2026.
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