en Neurology Neurology Original Article Original Article <span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="line-height:13.7pt"><b><i><span style="color:blue">Background</span></i></b><i><span style="color:blue">:</span></i> Anti-CD20 are among the high-efficacy DMTs commonly used in treating multiple sclerosis (MS). Long-term safety data on anti-CD20s are limited. There is convincing evidence of hypogammaglobulinemia in the long-term use of anti-CD20s, raising the likelihood of infection. Accordingly, there is an unmet need for de-escalation therapy in stable patients to reduce adverse events. Herein we aimed to describe our experience with ten relapse-remitting MS (RRMS) patients who were switched from anti-CD20s to the low-moderate efficacy DMTs.</span><br> <span style="line-height:13.7pt"><b><i><span style="color:blue">Methods:</span></i></b> This cohort study was conducted between January 2020 and February 2023 at the MS Research Center of Sina Hospital, Tehran, Iran, to identify the characteristics of RRMS patients who were switched from anti-CD20s to low-moderate efficacy DMTs within 12 months of the last anti-CD20 infusion. Patients were then followed up to 18 months after de-escalation.</span><br> <span style="line-height:13.7pt"><b><i><span style="color:blue">Results:</span></i></b> All patients were females, with a mean age of 39.3&plusmn;2.53-year-old and a mean disease duration of 9.7&plusmn;1.39 years. After a mean of 2.95&plusmn;0.44 years of treatment with anti-CD20s, patients were de-escalated to INF-&beta;1a (n=5), dimethyl fumarate (DMF) (n=3), fingolimod (n=1), and teriflunomide (n=1). The main reason for anti-CD20 discontinuation was an infectious concern. Within 18 months of follow-up, no patient developed clinical or MRI activity. Additionally, we did not find evidence of disability progression in any patients (P=0.13).<b> </b><span style="font-size:10.0pt"></span></span><br> <span style="line-height:13.7pt"><b><i><span style="color:blue">Conclusion</span></i></b><i><span style="color:blue">:</span></i> The present study is a real-world experience of de-escalating anti-CD20s to low-moderate efficacy DMTs, which suggests that at short-term follow-up, de-escalating anti-CD20s appeared to be effective and safe in RRMS patients.</span></span></span><br> &nbsp; Anti-CD20, B cell depleting monoclonal antibody, De-escalation, Relapse remitting multiple sclerosis, RRMS 126 131 http://caspjim.com/browse.php?a_code=A-10-646-15&slc_lang=en&sid=1 Sepideh Paybast sepideh.paybast@yahoo.com 100319475328460050533 100319475328460050533 No Department of Neurology, Imam Hossein Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Nasim Rezaeimanesh rezaeimaneshnasim@gmail.com 100319475328460050534 100319475328460050534 No Multiple Sclerosis Research Center, Neuroscience Institute; Tehran University of Medical Sciences, Tehran, Iran. Abdorreza Naser Moghadasi abdorrezamoghadasi@gmail.com 100319475328460050535 100319475328460050535 Yes Multiple Sclerosis Research Center, Neuroscience Institute; Tehran University of Medical Sciences, Tehran, Iran