Treatment of Multiple Sclerosis with Anti-CD20 Therapies: Experience of the Mohammed V Military Teaching Hospital

Abstract

Background: Anti-CD20 monoclonal antibodies, including rituximab (RTX) and ocrelizumab (OCR), have markedly improved the management of multiple sclerosis (MS) by reducing inflammatory disease activity. However, local evidence regarding their effectiveness and safety in real-world clinical practice remains limited. Objective: This study aimed to describe the patient profile and clinical evolution during anti-CD20 therapy at the Mohammed V Military Teaching Hospital. Methods: A retrospective longitudinal observational cohort study was conducted in September 2025 in the Department of Neurology at the Mohammed V Military Teaching Hospital in Rabat. It included patients diagnosed with active relapsing-remitting or progressive MS between 2000 and 2024 who initiated anti-CD20 therapy (OCR or RTX) between July 2021 and July 2025. Clinical, radiological, and safety data were collected retrospectively from medical records. Results: Forty-nine patients were included; 69% were female, and the mean age was 43.8 ± 10.8 years. Secondary progressive MS was the most frequent phenotype (51%). Thirty-six patients (73.5%) received RTX, and 13 (26.5%) received OCR. The median treatment duration was 11 [3; 22] months for RTX and 21 [7; 35] months for OCR. The mean EDSS score was 4.96 ± 1.84 at baseline and 5.11 ± 2.07 at the final follow-up. The annualised relapse rate was 0.15, and 65.3% of patients achieved radiological lesion stabilisation. Infusion-related reactions occurred in 38% of patients, mainly during the first infusion. Infections occurred in 49%, were predominantly mild to moderate, and included one severe infection. No neoplasm was observed. Conclusion: During follow-up, disability showed no statistically significant change, and radiological lesions stabilised in most patients. Infusion-related reactions and infections were common but predominantly mild to moderate; one severe infection and one death were recorded. These findings describe local clinical experience and emphasise the importance of continued monitoring for infectious risk during long-term anti-CD20 therapy.