Ocrevus is groundbreaking because, while it has been very effective for RRMS, it is also the first medication approved to treat primary-progressive multiple sclerosis (PPMS), a less-common form of the disease. According to the National Multiple Sclerosis Society, 85 percent of people with MS have RRMS, while 10 to 15 percent are diagnosed with PPMS. Before Ocrevus, there was very little doctors could do for their patients with PPMS other than provide medications and other therapies to treat the symptoms. Nothing slowed the progression of the disease itself. “We have been waiting, as clinicians who are passionate about our patients, for breakthroughs and FDA approvals in products like Ocrevus to come about,” says Aaron Boster, MD, the systems medical chief and neuroimmunology director of the MS center at OhioHealth Neuroscience in Columbus. “This changes the playing field and it is very exciting.” RELATED: 10 Essential Facts About Primary-Progressive MS
How Is PPMS Different From RRMS?
MS is an autoimmune disease in which the immune system attacks the myelin sheaths that protect nerve fibers in the brain, spinal cord, and optic nerve. The nerve fibers themselves can also be damaged or destroyed. This, in turn, slows or disrupts the transmission of nerve impulses from the brain, causing symptoms including fatigue, tingling and numbness, weakness, vision problems, and difficulty walking. In relapsing-remitting multiple sclerosis, the most common type, symptoms tend to flare periodically, followed by stretches of complete or partial recovery. Those with PPMS experience steadily worsening symptoms with few or no recovery periods. Nerve damage is generally more focused in the spinal cord than in the brain and can cause more significant disability than RRMS. RELATED: When MS Attacks the Spinal Cord Research into Ocrevus revealed that MS also involves B cells, another factor in immune response. Ocrevus targets and destroys a type of B cells called CD20-positive B cells. Results from clinical trials on Ocrevus are impressive in showing its effectiveness for both forms of the disease. Trials on people with RRMS, known as OPERA I and II, have made Ocrevus a first-line treatment for this form of the disease. Ocrevus showed greater effectiveness when compared with high-dose Rebif (interferon beta-1a) and reduced the annual relapse rate by 46 and 47 percent over a two-year period. Over 12 and 24 weeks, disability progression was reduced by 43 percent and 37 percent for both time periods and in both studies. The ORATORIO Phase III trial compared Ocrevus to placebo in individuals with PPMS. In this study, the likelihood of confirmed disability progression was reduced by 24 percent for at least 12 weeks and 25 percent for at least 24 weeks. Furthermore, the time it took patients to walk 25 feet (a standard test for progression) was reduced by 29 percent at 120 weeks.
Convenience a Benefit of Ocrevus
Another thing that makes Ocrevus appealing is the convenience factor. Existing DMTs are administered via pills, injections, or infusions, some requiring daily dosing, some weekly, some every two weeks, and some monthly. Ocrelizumab is given as an infusion twice a year. “Ocrevus has proved to be very convenient,” says Ellen Lathi, MD, the director of the Elliot Lewis Center for Multiple Sclerosis in Wellesley, Massachusetts. “Because you only need an infusion every six months, it allows patients to forget they have MS for 363 days of the year.” Risks and side effects of Ocrevus are comparable to those of other DMTs, though some research has suggested Ocrevus may raise the risk of breast cancer. As a precaution, women taking the medication are strongly advised by their physicians to stay up-to-date on mammograms.
Real-world Experiences of People Taking Ocrevus
According to Genentech, which manufactures the drug, approximately 30,000 prescriptions for Ocrevus have been written since its approval. Among the first people to receive an infusion of the medication is Kani Nicodemus, 52, a fitness instructor in Milford, New Hampshire. Nicodemus received a diagnosis of MS in 2001 and initially chose not to take any medication for it, instead focusing on her diet and exercise regimen. “Until 2008, I didn’t have many symptoms,” she says. “Then I developed neuropathy and fatigue, so my neurologist put me on Gilenya (fingolimod), and after that, Aubagio (teriflumonide).” In 2013, Nicodemus noticed new symptoms, including mobility issues with her left leg and a condition called “drop foot,” in which you have trouble lifting the front of your foot when you walk. As her symptoms progressed, her doctors came to the conclusion that she likely has PPMS. “There were no treatments for PPMS available during that time, so I continued with Aubagio and only discontinued it in January 2017,” says Nicodemus. “Two months later, I started Ocrevus. There hasn’t been any further progression, and my symptoms have been well-controlled. It takes less time for my leg to recover from the drop foot. For me that’s a huge benefit, because I am not a sit-still kind of person.” Trish Palmer, 34, of Columbus, Ohio, was diagnosed with RRMS in 2013 and had been on three different drugs without much improvement. “I had a very significant relapse in 2015,” she says. After six months on Ocrevus, Palmer feels the drug is working. “I had a clean MRI, and I’ve been more active in the last few months. I’m starting to feel confident that this is a long-term solution.”
Hope for the Future
It’s too soon to say how things will play out over time, but after one year, Dr. Lathi says the drug has gotten an “A-plus” from her patients. Dr. Boster points out that doctors “can’t reverse damage that’s already been done in patients, but we can halt further progression. I used to tell my patients, ‘I can make you get worse slower.’ Now I can say ‘Let’s make it stop.’ That’s very exciting.”
