Introduction and objective:
Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system, and leading to damage to nerve cells. Recent findings have underlined the importance of B lymphocytes in MS pathogenesis, the role of which includes the expression of the CD20 antigen. The aim of this scoping review is to summarize current data on immunological basis, clinical efficacy, and future perspectives of MS treatment options using anti-CD20 antibodies

Review methods:
A comprehensive literature review was conducted using the PubMed database and ClinicalTrials.gov website, with a particular focus on studies related to anti-CD20 monoclonal antibodies in MS treatment, published between 2018–2025.

Brief description of the state of knowledge:
Anti-CD20 therapies, such as rituximab, ocrelizumab, ofatumumab and ublituximab, successfully reduce relapse rates, disability progression, and MRI disease activity by depleting pathogenic B cells in some specific mechanisms of action, including ADCC, CDC, and ADCP. Despite high efficacy, some adverse events may occur. Injection related reactions, infections and hypogammaglobulinemia are most frequently identified. Some cases of cancers have been also been reported, which suggest the need for long-term observational studies. Moreover, reduced vaccination responses observed following prolonged B cell depletion, address the importance of optimal immunization prior to treatment initiation, and individualization of the approach to MS patients.

Summary:
Anti-CD20 medications constitute a significant step in MS treatment, effectively tackling pathogenic mechanisms mediated by B cells; however, their long-term impact on human immune system require ongoing evaluation studies. Clinical trials comparing different anti-CD20 drugs are being held currently, and their results may prove to be crucial for optimizing patients’ outcomes.