Photo: Stethoscope

Ocrelizumab

Ocrelizumab is a drug that, since early 2018, has a Europe-wide licence to treat relapsing MS and early primary progressive MS. Its brand name is Ocrevus.

This drug is now going through the process of trying to get approval to be used on the NHS in the different countries of the UK. It is available privately but costs many thousands of pounds.

Who can take ocrelizumab?

‘Ocrelizumab is used to treat ‘active’ relapsing MS. Its licence allows it to be used for early primary progressive MS too, but it’s not available on the NHS for that.

Relapsing MS

England, Wales and Northern Ireland:

Ocrelizumab can now be given on the NHS to a small number of people with relapsing MS.

You must have ‘active’ relapsing MS. This means you’ve been having relapses or MRI scans of your brain or spinal cord show you have new lesions.

You’ll only be given ocrelizumab if you qualify to get alemtuzumab (Lemtrada) and you can’t, or don’t want to, take that drug. So ocrelizumab is an alternative to alemtuzumab if that drug is unsuitable for you.

In Scotland:

The Scottish Medicines Consortium (SMC) decides whether a drug should be available on the NHS in Scotland. In July 2018 it decided ocrelizumab won’t be available for relapsing MS. They felt its benefits weren’t worth how much the drug cost. This will be looked at again, with a decision made in 2019. Then we hope Scotland will follow the rest of the UK in making this drug available for relapsing MS.

Primary progressive MS

England and Wales:

In September 2018 NICE decided not to make it available to treat primary progressive MS. They felt its benefits weren’t worth how much it cost. We're campaigning to change that.

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In Scotland:

The Scottish Medicines Consortium (SMC) decides whether a drug should be available on the NHS in Scotland.

When ocrelizumab didn't get the go-ahead from the SMC for use on the NHS for relapsing MS, the drug’s makers decided not to try and get the green light for it to be used for early primary progressive MS.

In Northern Ireland:

The NICE decision not to make ocrelizumab available in England and Wales means there are no plans to make the drug available on the NHS in Northern Ireland for early primary progressive MS

How does ocrelizumab work?

Your immune system makes special cells that attack and kill virus and bacteria. In MS these cells attack your nerves by mistake.

Ocrelizumab sticks to one type of these cells called B cells. This stops them getting into your brain and spinal cord where they would attack the myelin covering around your nerves. This stops inflammation and damage to the nerve.

You’re given this drug through a drip (an ‘infusion’) in hospital. You get the first dose as two separate infusions, two weeks apart. After that you have an infusion once every six months.

How well does ocrelizumab work?

MS drugs can be put into three groups based on how big their effect is against MS: ‘moderate, ‘good’ or ‘high’. Ocrelizumab is new, so it’s not yet certain how well it controls MS.

Relapsing MS

When this drug is used for relapsing MS it can be classed at the very least as ‘good’. Over time its effect may turn out to be ‘high’. This is based on how much it reduces relapses and slows down how fast people's disability gets worse.

Relapses dropped by:

46% compared to beta interferons

This means that in one trial, on average, people saw a 46% drop in the number of relapses they had. This was compared to people who took beta interferon, a standard treatment for MS.

In another trail the reduction was 47%.

Disability getting worse was slowed down by:

43% compared to beta interferons

This means that in a trial, on average, people saw a 43% drop in the risk of their disability getting worse. This was compared to people who took beta interferons.

In another trail the reduction was 37%. Looking at these two trails together the overall reduction was 40%.

Primary progressive MS

When ocrelizumab is used to treat primary progressive MS its effect is classed as ‘moderate’. This might not seem impressive but this the first drug to work at all against primary progressive MS.

Disability getting worse was slowed down by:

25% compared to a placebo

This means that in a trial, on average, people saw a drop of around 25% in the risk of their disability getting worse.This was compared to people who took a placebo, a dummy treatment with no drug in it.

The drug also helped people walk better, slowed down how fast their brains were shrinking and made lesions in the brain smaller.

What are the side effects of ocrelizumab?

Compared to other DMTs, the risk of side effects, especially serious ones, doesn’t seem high. Overall ocrelizumab is somewhere in the middle, between the drugs with the highest risk of serious side effects and those that are seen as the safest.

In trials side effects weren’t any more serious than what you get with beta interferons (among the safest DMTs).

Up to four in ten people had at least one fairly mild, short-lived reaction during or after their infusion. These included a skin rash, fever, sore throat, itching or flushing (going red in the face).

You’re more likely to get some infections when taking this drug. These include colds and infections of the chest and skin, cold sores and other herpes infections.

So far ocrelizumab seems to have far fewer side effects than you get with other DMTs that are as good at controlling MS. In trials more people taking it got cancer, but it’s not certain if this was a side effect of the drug.

There have been so far no definite cases in people with MS of this drug causing the brain infection progressive multifocal leukoencephalopathy (PML). But PML could be a risk because it’s happened in people taking this drug for other health problems.

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