Novartis finally received US approval yesterday of its subcutaneous version of ofatumumab, a drug that in a different formulation it had sold as Arzerra for leukaemia. Its new setting is multiple sclerosis, where it is known as Kesimpta, and can be self-administered; it is this convenience advantage that Novartis has pushed hard with the hope of distinguishing it from Roche’s intravenous Ocrevus, which is also an anti-CD20 antibody. This could be a tough fight, however: impressive reductions in relapse rates mean that Ocrevus is forecast to be market leader by 2026, according to EvaluatePharma 's sellside consensus. Kesimpta also looks expensive, with a wholesale acquisition cost of $83,000, higher than Ocrevus’s $65,000. The at-risk launch of Tecfidera generics this week by Mylan add another dimension to the shifts in this market. This came earlier than many had expected, meaning that the forecast numbers below are likely to change. Tecfidera is also an oral therapy, so Novartis will have to work hard to justify Kesimpta’s advantages.