June Halper: What Ocrelizumab Has Shown in PPMS

The US Food and Drug Administration (FDA) approved ocrelizumab (Ocrevus) in 2017 as the first novel therapy indicated for the treatment of patients with primary progressive multiple sclerosis (PPMS).

Since then, the biologic has had as much benefit treating patients as it has had in advancing understanding of aging patients.

In an interview with MD Magazine®, June Halper, RSN, APN-C, chief executive officer of the Consortium of Multiple Sclerosis Centers (CMSC), explained how clinicians now have real-world evidence of ocrelizumab’s benefit in early-onset patients—and also its limits in more progressed patients.

MD Mag: How has primary progressive multiple sclerosis care changed since the approval of ocrelizumab?

Halper: Well ocrelizumab actually was approved for the spectrum of MS. But of course, the first time it was actually carved out for primary progressive disease—which is as everybody knows the most ominous form. It used to be called chronic progressive MS.

It's great hope, it's a great hope. On the other hand, one of the frightening things that we've seen over the years is that somebody with primary progressive MS may have been diagnosed in their early 20s and today is in their 40s and that aging may not make that person eligible or at least responsive to ocrelizumab. We don't know enough about what aging does to the disease.

So, it's promising for sure and it's worth the try for sure, and the insurance will probably approve it. But then, when will it work? And that's that's the scary part of it.

I actually just met with the wife of a patient who's in his late 30s, who's had MS for about 18 years. And he did not respond to it. So the big question in my mind—the big black hole is, is there a window of time that the patient needs to be treated?

We know that early treatment in relapsing MS is the way to go. The best response is if you get them diagnosed and start them immediately, or as close to immediately. We don't know what that window is going to be with ocrelizumab, although everybody should be eligible for it.