RItuximab Versus Ocrelizumab in Relapsing-remitting Multiple Sclerosis.

Inclusion criteria

• Patients presenting a relapsing remitting MS according to Mac Donald 2017 criteria, with clinical or radiological criteria of activity (ie at least one relapse AND/OR one new T2 lesion in the last 12 months before inclusion);
• Age between 18 and 55 years
• EDSS ≤ 5
• Brain MRI within 6 months before inclusion
• For women of childbearing potential\*: effective contraception (effective contraception include oral contraception, intrauterine devices and other forms of contraception with failure rate \<1%, for the duration of the study and until 12 months after last dose administered) \* A woman is considered of childbearing potential (WOCBP), i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy.
• A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. However, in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient.
• Having signed an informed consent form
• Patients covered with social insurance
• Non-Inclusion Criteria:
• Secondary or primary progressive MS;
• Previous treatment by mitoxantrone, cladribine, alemtuzumab and anti CD20 therapies in the last two years;
• Previous treatment by fingolimod or natalizumab in the last 4 weeks;
• Treatment with high dose corticosteroids during the 30 days preceding the inclusion;
• Occurrence of a relapse less than 30 days before inclusion;
• Pregnancy or breastfeeding;
• Other neurologic or systemic disease;
• Concomitant participation or Participation in another therapeutic trial in the last 6 months;
• Incapacity to understand or sign the consent form;
• Contraindication to MRI;
• Contraindication to anti-CD20 therapies:
• Receipt of a live or live-attenuated vaccine within 6 weeks prior to randomization
• Active malignancy.
• Any ongoing infection
• Severe heart failure (New York Heart Association Class IV) or severe uncontrolled cardiac disease
• Positive test for HIV, hepatitis B or C, or tuberculosis
• Severe immune deficiency:
• Lymphopenia grade 3 (0.2 to 0.5 × 10\^9/L) or higher grades
• Neutropenia grade 3 (0.5 to 1.0 × 10\^9/L) or higher grades
• Known hypersensitivity or other known side effects for any of the study medications, including co-medications such as high glucocorticosteroids
• AST or ALT \>=3ULN
• Platelet (thrombocyte) count \< 100 x 10\^9/L
• Adults legally protected (under judicial protection, guardianship, or supervision), persons deprived of their liberty.