No evidence of fluctuations in daily step count between infusions in people with multiple sclerosis treated with anti-CD20 monoclonal antibodies

TL;DR

This study found no significant changes in daily step count before and after anti-CD20 infusions in MS patients, suggesting no 'wearing-off' effect.

Contribution

The study provides new evidence on the absence of step count fluctuations related to anti-CD20 therapy in MS.

Findings

No significant difference in daily step count was observed before and after infusions.

An average 3.3% post-infusion decrease in steps was noted but not statistically significant.

No associations were found between step count and participant characteristics like age or disability level.

Abstract

Patients with multiple sclerosis (MS) on some disease-modifying therapies (i.e., natalizumab), report a “wearing-off” effect characterized by increased symptoms directly before infusions. Prior research suggests this may reflect natural MS fluctuations rather than true treatment waning; however, this has not been confirmed for anti-CD20 agents (e.g., ocrelizumab). Daily step count (STEPS) can reflect overall function. This study examined temporal associations between anti-CD20 therapy infusions and STEPS.

Retrospective analysis evaluated data from two Fitbit-monitored cohorts (N = 145 total, 32 anti-CD20-treated participants) across 60 treatment cycles. Monthly STEPS were recorded directly pre- and three-month post-infusion over the six-month treatment intervals. Mixed-effects models evaluated the relationship between infusion timing, STEPS, and participant demographics, controlling for confounding variables.

No significant difference in STEPS was observed pre- versus post-infusion (p = 0.32). An average decrease of 3.3% was noted post-infusion but was not statistically significant. No associations between STEPS and participant characteristics (e.g., age, disability level) were identified. Individual variability existed, but no clear group-level trends emerged.

This study found no evidence of an association between timing of anti-CD20 infusion and changes in STEPS. Findings highlight the need for integrating objective measures with patient-reported outcomes and biomarkers in future research to better understand potential treatment fluctuations.

Figures