Parenteral anti-B cell therapy for multiple sclerosis: From origins to the creation of the Russian drug divosilimab

Multiple sclerosis is a chronic disease that leads to disability at the young, working age. Disease-modifying treatment are used to control multiple sclerosis. There are two models of therapy: escalation and induction. Recently, many experts have given preference to an induction approach to treatment, when highly effective drugs are prescribed as early as possible. One promising direction is parenteral anti- B cell therapy. The history of the development of this drug group begins with the successful use of Rituximab for the treatment of patients with multiple sclerosis. The results of the study were so impressive that this was the reason for prescribing this therapy off-lable in routine practice. And we are now noticing an increase in the number of patients on therapy with the Rituximab in European countries. Subsequently, the Ocrelizumab was developed, which became the first and only drug for the treatment of primary progressive multiple sclerosis. Divosilimab (Russian-made drug) was registered in 2023, which is also considered original due to the specific modified glycosylation scheme of the Fc-fragment. Having a sufficient selection of highly effective drugs, we must remember that in the pursuit of effectiveness we must not forget about the safety of the therapy. The issues of the possible use of an extended administration interval and reduction of the used dosage with long-term use of this type of therapy are discussed.