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Early Versus Delayed Treatment with Ocrelizumab: A Multicenter, Real-World Observational Study in People with
Enrique Alvarez1, Robert T Naismith2, Le H Hua3
1Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
Neurology and Therapy
|May 30, 2026
Summary
First-line ocrelizumab treatment in multiple sclerosis (MS) showed better outcomes than later use. Early high-efficacy disease-modifying therapies (HE-DMTs) reduce disability worsening and need for walking aids in MS patients.
Area of Science:
- Neurology
- Immunology
- Clinical Research
Background:
- Growing evidence supports early use of high-efficacy disease-modifying therapies (HE-DMTs) in multiple sclerosis (MS).
- MS treatment often follows an escalation approach, delaying HE-DMTs.
- Real-world outcomes of ocrelizumab as first-line (1L) versus second-line or later (2L+) therapy require characterization.
Purpose of the Study:
- To compare the real-world effectiveness of ocrelizumab as 1L versus 2L+ therapy in people with MS (pwMS).
- To evaluate clinical outcomes including disability worsening, need for walking aids, relapse rates, and MRI measures.
Main Methods:
- Analysis of real-world data from 403 pwMS across four US centers.
- Comparison of ocrelizumab effectiveness in 1L (n=309) versus 2L+ (n=94) treatment groups.
- Primary outcome: time to confirmed disability worsening (PDDS). Secondary outcomes: time to walking aid, relapse rate, MRI measures (lesion load, brain volume).
Main Results:
- 1L ocrelizumab was associated with significantly less confirmed disability worsening (25.8% vs 42.6%) and reduced need for walking aids (6.5% vs 27.4%) compared to 2L+.
- The 1L group showed a significantly lower change in T2 lesion volume and reduced risk of new T2 lesions.
- No significant differences were observed in relapse rates or brain volume changes between the groups.
Conclusions:
- First-line treatment with HE-DMTs like ocrelizumab demonstrates improved clinical outcomes in MS patients compared to delaying to 2L+ therapy.
- This study supports the benefit of initiating high-efficacy treatments early in the management of MS.
- Real-world data reinforce the efficacy of ocrelizumab when used as an initial treatment strategy.
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