Could rituximab revolutionize multiple sclerosis treatment in Brazil? The missed opportunity for fewer relapses and lower costs.

Multiple sclerosis (MS) is a leading cause of neurological disability in young adults, affecting an estimated 2.8 million people worldwide. Early treatment with high-efficacy therapies is associated with better long-term outcomes, yet access to these therapies remains limited in many countries, including Brazil. Rituximab, a B-cell depleting agent, has emerged as a highly effective, safe, and cost-saving treatment for MS. A randomized trial and observational studies demonstrate that rituximab is superior in reducing relapse rates compared to commonly used first-line therapies. Rituximab also has a well-established safety profile and is associated with lower overall treatment costs. Although rituximab remains off-label for MS, it is supported by expert societies, endorsed by patient organizations, and has been added to the World Health Organization's list of essential medicines. We strongly recommend rituximab as an early treatment option for MS in Brazil, where its adoption could improve outcomes, reduce health inequities and lower healthcare system costs.