Real World Study Finds Ocrevus, Helps Highly Disabled People with MS

Ocrevus (ocrelizumab), marketed by Genentech, is a CD20-directed monoclonal antibody FDA-approved in 2017 to treat relapsing forms of multiple sclerosis (MS) as well as primary progressive MS (PPMS). It's currently the only disease-modifying treatment approved for treating PPMS.

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Ocrevus targets the CD20 protein found on B cells heavily involved in the inflammatory process that contributes to worsening of MS symptoms. The treatment has been found effective and is widely used in both relapsing and progressive forms of MS. However, clinical trials that led to its approval largely excluded individuals with MS with higher levels of disability. Thus, the effect of Ocrevus on this population is unclear.

To gain more knowledge, Maria Houtchens, M.D. and Danielle Howard, M.D., from the Brigham and Women’s Multiple Sclerosis Center in Boston, conducted a retrospective chart review of patients seen at the center who started Ocrevus treatment between July 2017 and July 2021.

Specifically, Houtchens and Howard analyzed the records of patients with an Expanded Disability Status Scale (EDSS) score of 6.5 or higher at the time they began receiving Ocrevus. This disability score indicates the patient needed two walking aids to walk 100 meters (328 feet) without resting.

The results from the study were published in the February 2024 issue of Multiple Sclerosis and Related Disorders.

A total of 62 patients were included in the final analysis. Of these, 79% had secondary progressive MS (SPMS), and 21% were diagnosed with PPMS. The median age of the participants was 62.1 years, and the median EDSS score was 7. Ocrevus treatment was started in 41.9% of patients due to clinical evidence of disease progression, in 27.4% due to patient-reported progression, and in 12.9% to prevent future progression.

The average duration of treatment was about three years. A total of 46.8% of participants discontinued Ocrevus before the end of the study period. Reasons for discontinuation included side effects (58.6%), disease progression or lack of benefit (41.4%), and concern about the COVID-19 pandemic (20.7%).

About 53% of patients reported side effects. The most common were frequent infections (63.6%) and infusion reactions (24.2%). A total of 51.6% of participants continued Ocrevus treatment throughout the study period (an average of about 3 years). Of these, 66.1% remained clinically stable, as evidenced by a mean end EDSS score of 7, and 29% reported that their disease remained stable.

Based on this data, the researchers conclude that Ocrevus may stabilize disability progression in patients with MS and a high disability level.

Houtchens and Howard wrote, “Our study reports on the safety and effectiveness of [Ocrevus] in MS patients with significant levels of disability and suggests that it may be a useful therapeutic strategy in up to a third of these patients in appropriate clinical setting.”

“More research is needed to help identify those highly disabled [people with MS] who would most benefit from [Ocrevus] use,” the authors added.