B-cell depleting therapies cut MS relapses but don't move the needle on disability

A large real-world study has good news — and a reality check — for MS treatment. The Pan-European MultipleMS study followed 509 newly diagnosed, treatment-naive MS patients across seven European countries for 2 years, comparing outcomes across injectable, oral, high-efficacy, and B-cell depleting therapies (BCDTs). BCDTs came out on top for reducing relapses and brain lesion growth, but no treatment group showed a meaningful edge when it came to disability progression.

The findings, published in Neurology Open Access, suggest that while BCDTs are strong at suppressing acute inflammation, chronic neurodegeneration may be advancing independently — a gap that current therapies haven't yet closed. Researchers also noted that patient selection likely influenced results, since patients with more severe disease tended to receive stronger treatments.

By the Numbers:

• BCDTs reduced annualized relapse rate by 62% vs. oral platform therapies (ARR: 0.04 vs. 0.16)
• BCDTs also reduced T2 lesion volume (volume ratio: 0.87)
• 93.8% of BCDT patients stayed on their initial therapy at 2 years vs. ~72% average across other groups
• No significant differences in EDSS disability scores or serum neurofilament light chain (sNfL) across treatment groups at 2 years

Why it matters: These findings highlight a critical unmet need in MS care — current high-efficacy therapies suppress relapses well but may not adequately address the chronic, compartmentalized CNS inflammation driving long-term disability. Emerging agents like Bruton tyrosine kinase inhibitors may offer a new path forward.