Two-year OCT follow-up in multiple sclerosis patients on Ofatumumab shows retinal preservation over non-antiCD20 treatments

Introduction: Optical coherence tomography (OCT) can detect neuroaxonal loss in multiple sclerosis (MS) patients, with thinning of the ganglion cell layer (GCL) reflecting neurodegeneration. Ofatumumab (OMB), a subcutaneous anti-CD20 monoclonal antibody, has demonstrated efficacy against inflammatory activity, though its neuroprotective potential is less established. This study aimed to assess longitudinal OCT changes in MS patients treated with OMB compared to those receiving non-anti-CD20 disease-modifying treatments (DMTs). Methods: This longitudinal observational study included relapsing–remitting MS patients initiating Ofatumumab, with OCT and EDSS assessments at baseline and 24 months, compared with a retrospective control group on non-anti-CD20 DMTs. Eyes with prior optic neuritis were excluded. Longitudinal GCL thickness was analyzed using a nested linear mixed-effects model, including random intercepts for patients and eyes nested within patients and multivariate linear regression adjusting for baseline characteristics. Results: We analyzed 85 eyes from 47 patients (OMB: 46 eyes; control: 39 eyes). Baseline GCL was lower in OMB patients, who also had longer disease duration and higher EDSS. Over 24 months, GCL remained stable in OMB patients (+ 0.28 µm/year; p = 0.06), while controls showed significant thinning (− 0.99 µm/year; p < 0.001). In the adjusted multivariate regression model including age, sex, baseline GCL, EDSS, and disease duration, treatment with OMB was independently associated with reduced GCL loss (β = 2.41 µm/year, 95% CI 1.38–3.43, p < 0.001). Conclusions: OMB treatment was associated with significant retinal preservation, independent of baseline differences and confounders. These results suggest a potential neuroprotective effect of B-cell depletion in MS and support the utility of OCT as a sensitive biomarker for treatment monitoring.