b"ThrowerB-cell therapies represent one of theremained untreated. Additional cladribine doses most effective classes of disease-modifyingwere safe and helped reduce relapse rates therapies for managing MS. These includewithout causing serious side effects. Disability rituximab, Ocrevus (ocrelizumab), Kesimptalevels stayed stable. The findings suggest (ofatumumab),andBriumvi(ublituximab).continuing or restarting cladribine treatment An area of research interest with these therapiesafter the initial course may help maintain MS is focused on dosing. The question is whether wecontrolincertainpatients.Thestudywas need higher or lower doses of these medicationspublished in Multiple Sclerosis and Related for the best treatment results and safety.Disorders. Arguing for higher dosing was based on aThrower- Mavenclad (cladribine) is a highly retrospective look at results from the originaleffective oral disease-modifying therapyfor phase 3 studies of Ocrevus. In that analysis,relapsing forms of MS. The drug is typically higher serum concentrations of Ocrevus weregiven as two courses, one year apart. Extension linked to less disability progression. Resultsstudies have shown ongoing effectiveness from the MUSETTE study failed to show anyand safety 15 years after initial treatment. An added slowing of disability progression withunanswered question, however, has been what doses of 1200 mg or 1800 mg compared tothe plan is if we see breakthrough MS activity the standard dose of 600 mg of Ocrevus. after the initial therapy with Mavenclad. In this In contrast, there are several studies arguingstudy, the researchers looked at the efficacy that lowered doses of Ocrevus or rituximaband safety of giving additional courses of may be as effective as standard dosing. ThisMavenclad ve years after the initial treatment. study examined the efficacy of rituximab everyThere were no new safety issues with the nine months versus every six months andadditional doses. MS disability and relapse rates found no difference in relapse rates or new MRIremained stable. MS is a lifelong challenge, lesions. Prior studies have examined 500 mgand we welcome new therapy options that doses of rituximab compared to 1000 mglook into the future. dosesandsawnodifference.OcrevushasCrap gap not reected in step countsbeen studied at dosing intervals of six monthsResearchers at the University of California, and nine months, with no differences found. San Francisco, studied whether step counts As we think about choosing the best MSchanged between infusions in people with therapy for an individual, we need to nd thatMS treated with anti-CD20 therapies (such as right balance between efficacy and safety, andocrelizumab or rituximab). They analyzed data keep in mind there is no one size ts all solution.from 32 adults who wore Fitbits during 60 No new safety issuestreatment cycles. The study found no signicant with additional Mavenclad doses change in daily steps before versus after infusions, Researchers in Germany across six centerssuggesting no apparent wearing-off effect. studied 166 adults with highly active relapsingParticipants' age, MS type, or disability level MS who had previously received two years ofdid not affect results. The study shows that cladribine tablets. The study evaluated the safetydaily step tracking may not reect symptom and effectiveness of giving additional cladribinechanges tied to treatment timing, and future doses in years five and six. Some patientsresearch should combine physical activity data received one or two extra courses, while otherswithotherhealthmeasures.Thendings 39 msfocusmagazine.org"