Ocrelizumab in highly disabled progressive multiple sclerosis patients

Area of Science:

• Neurology
• Immunology
• Clinical Therapeutics

Background:

• Ocrelizumab, an anti-CD20 monoclonal antibody, is approved for relapsing-remitting (RRMS) and primary progressive multiple sclerosis (PPMS).
• Real-world data on ocrelizumab use in highly disabled MS patients (EDSS ≥ 6.5), who were excluded from initial trials, is limited.
• High disability levels may pose barriers to treatment access and require specific consideration for safety and efficacy.

Purpose of the Study:

• To assess the real-world accessibility, tolerability, and therapeutic outcomes of ocrelizumab in multiple sclerosis patients with significant motor disability.
• To characterize side effect profiles, treatment persistence, and disease stabilization in this understudied patient group.

Main Methods:

• Retrospective review of patients with Expanded Disability Status Scale (EDSS) 6.5 or greater initiating ocrelizumab.
• Exclusion criteria included recent rituximab use, concurrent immunosuppressants, or alternative diagnoses.
• Data collected on adverse events, treatment duration (>1 year), and MS disease activity (stabilization vs. progression).

Main Results:

• 62 highly disabled MS patients (median EDSS 7.0) were included in the analysis.
• Over half (51.6%) continued ocrelizumab for an average of 36.5 months; 46.8% discontinued treatment, primarily due to side effects or lack of benefit.
• Disease stabilization was observed in 66.1% of patients, with 29.0% reporting subjective stability, while 25.8% experienced worsening disability.

Conclusions:

• Ocrelizumab can achieve disease stabilization in a subset of highly disabled MS patients.
• Careful risk-benefit assessment is necessary due to the potential for adverse events in this high-risk population.
• Further research is warranted to optimize treatment strategies for MS patients with advanced disability.