With the arrival of two new medications, the treatment of multiple sclerosis has reached a new frontier.“We are down now to relapse rates of 1 every 5 years or better,” said Bruce A. Cohen, M.D., during his lecture at the Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting. “Our problem is now no longer whether we can treat relapsing-remitting MS (RRMS), but rather, how do we use these agents?”

Cohen, who is a professor of neurology at the Feinberg School of Medicine at Northwestern University, provided physicians with an overview of the two newest MS drugs – daclizumab (Zinbryta) and ocrelizumab (Ocrevus) – as well as more established therapies for treating the disease during his lecture titled, “Personalizing the Personalizing the Management of Multiple Sclerosis: A 3 Dimensional View of Current and Emerging Therapies,” on Wednesday, May 24.

The goals of any MS therapies should be to limit disease activity and prevent relapse and progression, Cohen said. These factors need to be balanced with limiting treatment-related adverse effects. Physicians also need to address patient lifestyle choices – such as smoking – as well. Cohen advised physicians that treatment itself should be targeted toward relieving symptoms, shortening relapses, and reducing frequency of relapses. Therapies should be initiated as soon as possible, before disability begins,

Cohen said, adding that a multi-disciplinary approach to care best serves patients. The newest drug available for MS treatment, ocrelizumab (Ocrevus) became available to physicians in March 2017.

Ocrelizumab, Cohen explained, “depletes pre-B cells, mature B cells, memory B cells through antibody-dependent cell-mediated phagocytosis, antibody-dependent cell mediated cytotoxicity, complement-dependent cytotoxicity, and introduction of apoptosis.”

It does this without damaging lymphoid stem cells and plasma cells. Researchers put ocrelizumab through 3 Phase 3 trials, including two which occurred in parallel. The parallel trials determined that ocrelizumab was highly effective compared to interferon beta-1a SC, with low annualized relapse rates, in treating RRMS. MRI outcomes also showed benefits consistent with reduction of inflammatory lesions. “Perhaps one of the more exiting events this year was the third trial of ocrelizumab,” Cohen said, which looked at the drug’s efficacy against primary progressive MS (PPMS) compared to a placebo. At 12 weeks, ocrelizumab kept disability progression to 32.9% vs. 39.3% in the placebo group. After 24 weeks, the figures stood at 29.6% vs. 35.7%… [Read More]

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