# Ocrelizumab vs Ofatumumab: Relapse and Disability Outcomes (public)

## 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

## Results

### Characteristics of Included Studies

| Study                | Study Design                                        | Registry Source                | Population Size             | Follow-up Duration  | Full text retrieved | 
|----------------------|----------------------------------------------------|-------------------------------|----------------------------|---------------------|---------------------|  
| Zanghì et al., 2024  | Retrospective cohort, multicenter, propensity-matched | Italian multiple sclerosis centers | 396 (ocrelizumab: 216, ofatumumab: 180) | Mean 13.2 months     | Yes                |  
| Zhu et al., 2022     | Retrospective, multicenter, inverse probability of treatment weighting, registry | MSBase                       | 1045                      | ocrelizumab: median 1.8 years; cladribine: 1.1 years; natalizumab: 3.6 years | Yes |  
| Ghajarzadeh et al., 2025 | Systematic review/meta-analysis                    | Multiple                     | No mention found        | No mention found         | No                  |  
| Cunha et al., 2025   | Retrospective cohort                               | No mention found             | 59                       | No mention found         | No                  |  
| Epstein et al., 2021 | Retrospective chart review                         | No mention found             | 56                       | 2 years                    | No                  |

## Effects

### Annualized Relapse Rate

| Study                | Treatment                                                   | Annualized Relapse Rate (95% CI)                | Study Population                   | Effect Size                    |
|----------------------|------------------------------------------------------------|------------------------------------------------|-----------------------------------|--------------------------------|  
| Zanghì et al., 2024  | ocrelizumab: 0.059; ofatumumab: 0.038 (p=0.185)          | Relapsing multiple sclerosis                     | No significant difference         |  
| Zhu et al., 2022     | ocrelizumab: 0.07 (0.04–0.13); natalizumab: 0.11 (0.09–0.14); cladribine: 0.25 (0.12–0.57) | Relapsing-remitting multiple sclerosis post-fingolimod | ocrelizumab superior to cladribine, lower than natalizumab |
| Cunha et al., 2025   | rituximab: 0.08 (post-switch); ocrelizumab/ofatumumab: no significant change | Post-natalizumab                      | No significant change for ocrelizumab/ofatumumab |  
| Boz et al., 2023     | ocrelizumab: 0.08 (0.06–0.11); natalizumab: 0.09 (0.07–0.12); fingolimod: 0.17 (0.15–0.19) | Relapsing-remitting multiple sclerosis                     | ocrelizumab/natalizumab similar, both superior to fingolimod  |
| Zhu et al., 2023     | ocrelizumab: 0.06 (0.04–0.08); fingolimod: 0.26 (0.12–0.48); dimethyl fumarate: 0.27 (0.12–0.56) | Relapsing-remitting multiple sclerosis post-natalizumab | ocrelizumab superior to both |
| Roos et al., 2024    | ocrelizumab: 0.05; cladribine: 0.09; natalizumab: 0.06; fingolimod: 0.12; alemtuzumab: 0.04 | Relapsing-remitting multiple sclerosis                     | ocrelizumab superior to cladribine/fingolimod, similar to natalizumab/alemtuzumab |

### Confirmed Disability Progression

| Study                | Treatment                                                    | Confirmed Disability Progression Rate           | Time to Progression  | Statistical Significance      |
|----------------------|------------------------------------------------------------|------------------------------------------------|---------------------|-------------------------------|  
| Zanghì et al., 2024  | ocrelizumab/ofatumumab: 0%                                | 12 months                                      | No difference       |  
| Zhu et al., 2022     | ocrelizumab/natalizumab: no mention found                | No mention found                              | No significant difference|
| Cunha et al., 2025   | ocrelizumab/ofatumumab: no significant change             | No mention found                              | No significant difference for ocrelizumab/ofatumumab|

### Comparative Effectiveness

Direct registry-based comparisons of ocrelizumab and ofatumumab:

- Zanghì et al., 2024: No significant difference in annualized relapse rate or confirmed disability progression between ocrelizumab and ofatumumab over 12 months.
- Cunha et al., 2025: No significant difference in annualized relapse rate or Expanded Disability Status Scale change for ocrelizumab and ofatumumab.

## References

- [A. Zanghì et al., 2024](/content/review/117726f0-e88f-46ec-ad40-55f5f1d5e51a/source/432031f189ed486ab783b3bc8455289b/index.html) - Ocrelizumab and ofatumumab comparison: an Italian real-world propensity score matched study.
- [Chao Zhu et al., 2022](/content/review/117726f0-e88f-46ec-ad40-55f5f1d5e51a/source/9ae6c74662fc408683abdae52fc2e68b/index.html) - Comparing switch to ocrelizumab, cladribine or natalizumab after fingolimod treatment cessation in multiple sclerosis.
- Many more citations follow....