Ocrelizumab vs Ofatumumab: Relapse and Disability Outcomes

What is the annualized relapse rate and confirmed disability progression with ocrelizumab vs ofatumumab in registry data?

In registry studies, ocrelizumab and ofatumumab show comparable annualized relapse rates (0.059 vs 0.038, p = 0.185) and both achieve 0% confirmed disability progression at 12 months.

Abstract

Registry studies in multiple sclerosis report that ocrelizumab and ofatumumab yield comparable outcomes. In one large, multicenter, propensity‐matched study (Zanghì et al., 2024), the annualized relapse rate was 0.059 with ocrelizumab versus 0.038 with ofatumumab (p = 0.185), and both treatments showed 0% confirmed disability progression over 12 months. A small post–natalizumab cohort (Cunha et al., 2025) likewise observed no significant change in relapse rate or in Expanded Disability Status Scale scores between ocrelizumab and ofatumumab. Other registry reports of ocrelizumab document relapse rates ranging from 0.014 to 0.11, with very low rates of confirmed disability progression over follow-up intervals from 6 months to several years.

These findings indicate that, based on available registry data, ocrelizumab and ofatumumab produce similar outcomes in annualized relapse rate and short-term disability progression among patients with multiple sclerosis.

Methods

We analyzed 40 sources from an initial pool of 999, using 8 screening criteria. Each paper was reviewed for 7 key aspects that mattered most to the research question.

Papers identified with Elicit search

• n = 999

Papers screened out

• n = 959

Papers included for extraction

• n = 40

Data extraction

We asked a large language model to extract each data column from each paper.

Annualized Relapse Rate (ARR)

• Baseline ARR: 0.059 (ocrelizumab) vs 0.038 (ofatumumab), p=0.185
• On-treatment ARR: Varies by study
• Statistical significance of differences between groups: p=0.185

Disability Progression

• 12-week confirmed disability progression: 0% for both ocrelizumab and ofatumumab
• Statistical Significance: No significant difference observed

Summary of study characteristics:

• Study design:
  • 28 studies were retrospective.
  • 7 studies were prospective.
  • 2 studies were systematic reviews or meta-analyses.
• Registry source:
  • Most commonly MSBase (8 studies)

Effects

Annualized Relapse Rate

Confirmed Disability Progression

Registry Data Considerations

• Observational design, potential confounding, and differences in patient populations, prior treatment history, and follow-up duration may affect comparability across studies.

References

• A. Zanghì et al. (2024). Ocrelizumab and ofatumumab comparison: an Italian real-world propensity score matched study. Journal of Neurology
• Sahla El Mahdaoui et al. (2022). Intravenous ofatumumab treatment of multiple sclerosis: An observational study. Multiple Sclerosis and Related Disorders
• X. Montalban et al. (2023). Real‐world evaluation of ocrelizumab in multiple sclerosis: A systematic review. Annals of Clinical and Translational Neurology