# 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.

## Key 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.