Anti-CD20 monoclonal antibodies in the treatment of multiple sclerosis: Mechanisms of action, clinical efficacy, safety, and contemporary therapeutic perspectives

Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system in which B lymphocytes play a central role in disease pathogenesis. The development of anti-CD20 monoclonal antibodies has transformed the therapeutic landscape of MS by providing highly effective disease-modifying therapies with sustained reductions in relapse activity, magnetic resonance imaging disease activity, and disability progression. This review summarizes the current evidence regarding the biological rationale for B-cell depletion and discusses the mechanisms of action, efficacy, safety, and clinical applications of rituximab, ocrelizumab, ofatumumab, and ublituximab. Particular attention is given to adverse events, including infusion- and injection-related reactions, infections, hypogammaglobulinemia, vaccine responsiveness, and long-term monitoring strategies. Current treatment recommendations and the evolving role of anti-CD20 therapies within contemporary MS management are also reviewed. Overall, anti-CD20 monoclonal antibodies represent a cornerstone of modern MS therapy, offering substantial clinical benefit when combined with individualized patient selection, appropriate monitoring, and preventive measures.