Ublituximab for relapsing MS — SCE Neurology MCQ

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HardMultiple sclerosisUblituximab for relapsing MSSCE Neurology

A patient with highly active relapsing multiple sclerosis has breakthrough relapses on a moderate-efficacy drug. JCV antibody index is high, hepatitis B screening is negative and she favours high-efficacy treatment without natalizumab-associated PML risk. Which class is a reasonable specialist option?

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Correct answer: C — Anti-CD20 therapy after vaccination and infection screening

The best answer is “Anti-CD20 therapy after vaccination and infection screening”. Anti-CD20 therapy is a high-efficacy MS strategy whose risks include infection, hepatitis-B reactivation and hypogammaglobulinaemia; pretreatment screening, vaccination and ongoing monitoring are central to selection. “Long-term daily prednisolone as maintenance disease modification” is less appropriate because chronic systemic corticosteroids have substantial toxicity and are not standard relapse prevention “Aspirin as relapse-prevention therapy” is less appropriate because antiplatelet therapy does not suppress MS inflammation “Pyridostigmine for central demyelination” is less appropriate because pyridostigmine treats neuromuscular transmission failure “No escalation despite ongoing inflammatory activity” is less appropriate because continued relapses and enhancing lesions justify shared escalation discussion

Reference: NICE NG220: Multiple sclerosis in adults — recommendations. https://www.nice.org.uk/guidance/ng220/chapter/Recommendations Ocrevus 300 mg concentrate for solution for infusion: SmPC. https://www.medicines.org.uk/emc/product/8898/smpc