Ocrelizumab Effective at Controlling Relapse in Patients with Multiple Sclerosis

Ocrelizumab is an effective treatment option to control relapse risk and disability worsening in patients with multiple sclerosis (MS), according to recent findings published in BMJ Neurology Open.

Ocrelizumab, a humanized anti-CD20 Immunoglobulin G antibody, was approved for treatment of relapsing forms of MS and primary progressive MS in 2017 following phase 3 trials.

In these trials, patients over the age of 55 were excluded, making the data not widely applicable to older patients who more commonly experience adverse events.

Researchers aimed to address risk of infection and adverse events for the broader population of patients with MS treated with ocrelizumab.

“Given the age and comorbidity restrictions in the phase III clinical trials, our registry was established to evaluate safety and clinical outcomes in a community-based population of patients treated with ocrelizumab, with the hope of studying a cohort more consistent with a real-world population of eligible patients with MS,” wrote Kyle Smoot, MD, Providence Multiple Sclerosis Center, Providence Health and Services, Portland, Oregon, and co-researchers.

A total of 355 adult patients with MS prescribed ocrelizumab were enrolled in this observational study.

Researchers used data of patients who participated in the Providence Ocrelizumab Registry (POR) study, which aimed to determine if use of ocrelizumab in a general MS population would have different clinical outcomes and risks when compared to controlled trials, to observe demographic, clinical, MRI, medication history, and laboratory data at the start of medication and at each following 600mg ocrelizumab treatment.

Observed baseline data included recently previously prescribed disease-modifying treatments, relapses 1 year prior to beginning ocrelizumab treatment, magnetic resonance imaging (MRI) results prior to ocrelizumab treatment, and the Expanded Disability Status Scale.

Researchers continued to monitor MRI and Expanded Disability Status Scale, in addition to adverse effects and hospitalizations.

Patients receiving the first course of ocrelizumab saw higher rates of infusion reactions, though subsequent risk went down with each infusion. Respiratory infections(40.1%) and urinary tract infections (33.1%) were common adverse events. Infections led to 25 hospitalizations.

Researchers noted there wasn’t a statistically significant difference in percentage of infections among patients across age groups.

The data showed ocrelizumab is effective in controlling relapses, with an annualized relapse rate in patients taking ocrelizumab of 0.09. Prior to ocrelizumab, the annualized relapse rate in this cohort was 0.34 during the two years prior to the study.

As measured by the Expanded Disability Status Scale, there was an absence of disability progression. MRI outcomes for patients on ocrelizumab were positive.

A total of 43 patients discontinued use of ocrelizumab after 6 to 19 months: 24 patients due to side effects, 15 patients due to relapse, and 4 due to death.

While only 12.1% of patients discontinued ocrelizumab, researchers said infections resulting in hospitalizations are a concern.

“We believe that this study provides valuable information concerning the use of ocrelizumab in a large community-based MS centre, and may assist in future decision-making regarding the selection and management of patients who are potential candidates for ocrelizumab therapy,” Dr Smoot et al concluded.
 

Smoot K, Chen C, Stuchiner T, Lucas L, Grote L, Cohan S. Clinical outcomes of patients with multiple sclerosis treated with ocrelizumab in a US community MS center: an observational study. BMJ Neurol Open. 2021;3(2):e000108. Published 2021 Jul 7. doi:10.1136/bmjno-2020-000108