Ocrelizumab: A Historic Multiple Sclerosis Treatment

Ocrelizumab made history in March 2017 when it became the first drug approved by the US Food and Drug Agency (FDA) for the treatment of primary progessive multiple sclerosis (PPMS). What's ironic is the monoclonal antibody intravenous infusion drug is actually more effective at treating another form of multiple sclerosis (MS).

While ocrelizumab opens a door for PPMS treatment that's been considered closed for the past 4 decades of advancing treatment for the neurological condition, it showed even greater efficacy in treating relapsing-remitting multiple sclerosis (RRMS) — of which there's already more than a dozen approved treatments.

Stephen Krieger (pictured), MD, associate professor at the Mount Sinai Hospital, spoke with MD Magazine recently about the extension trial results of PPMS' first drug that proves its duality, and what ocrelizumab means as groundbreaking treatment.

What is the current state of RRMS and its treatments?

Krieger: RRMS is the version of MS we’ve had the most success at treating. We now have 15 treatments approved for the relapsing-remitting disease. The most recently approved was ocrelizumab, which was approved in the early part of 2017. We’re moving towards looking at agents that have had comparator studies, drugs that show they’re not just efficacious versus placebo. This is an example of a successful active comparator — successful studies for relapsing MS for preventing new lesions, new relapses, and disability.

They’ve started to release the data from ocrelizumab from its extension study, and that data this spring was even more impressive. Patients treated in the 1-year extension with ocrelizumab were shown to have basically zero enhancing lesions, and we’ve really never seen anything like that in our field before. It goes to show what can be accomplished over the longer term in treating relapsing MS with that agent.

How has ocrelizumab changed the state of MS treatment?

Krieger: We first saw the data for ocrelizumab back in the fall of 2015, so I think there’s been interest in this agent for relapsing disease, and for PPMS, for quite some time now. Patients will be asking about it, and I think it’s important for us treating MS to be familiar with the pros and cons of ocrelizumab. Its efficacy in relapsing MS was very substantial.

The efficacy in PPMS was modest, but it was statistically significant. So, I think, in my relapsing patients, it’s a somewhat different conversation about high efficacy and the risks that may be associated with that. And in primary progressive patients, it’s a more tempered conversation to think about what they can expect from a medicine that may slow down the disability for them, and also all the safety issues we have to think about there, too.

So, the risk-benefit ratio is a little bit different for relapsing patients considering ocrelizumab, and progressive patients considering ocrelizumab. But I think the whole field feels that it’s a step forward — especially to have options that are approved for PPMS, which we haven’t had until now.

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