Ocrevus (ocrelizumab) is the first and only drug to manage primary-progressive multiple sclerosis (PPMS). Its approval in March 2017 was big news in the MS world because there has been very little that MS health care providers could do for patients with PPMS, and Ocrevus offers hope to these people. HealthCentral asked Aliza Ben-Zacharia, Dr.N.P., a nurse practitioner at The Corrine Goldsmith Dickinson Center for Multiple Sclerosis at The Mount Sinai Medical Center in New York City, some questions about the new drug.
HealthCentral (HC): What kind of drug is Ocrevus and how does it work?
Dr. Aliza Ben-Zacharia (ABZ): Ocrevus is a disease-modifying therapy (DMT) in a class known as monoclonal antibodies. We don’t know the exact way that it works to help PPMS, but it appears to deplete the number of circulating B cells in the body. B cells are immune cells that cause inflammation and they may directly or indirectly damage or cause nerve fibers to die — what’s known as neurodegeneration. This damage is one of the hallmarks of MS.
HC: Who is the drug right for?
ABZ: The drug, which is given by an intravenous infusion every six months, is approved for people with PPMS and relapsing forms of MS. However, even if you have PPMS, if your disease has been stable for a long time you don’t need to rush to try Ocrevus. It’s typically reserved for people whose MS is advancing.
HC: What can patients expect if they take Ocrevus?
ABZ: If you have PPMS, it may delay the progression of your disability. It doesn’t appear to improve disability that already exists or improve function.
Genentech/Roche, the pharmaceutical company that makes Ocrevus, conducted three clinical trials of the drug, including the ORATORIO study in 732 patients with PPMS. In this study, subjects received infusions every six months for about three years. The researchers found that people who received ocrelizumab had a 24 percent lower risk of having their disability progress at 24 weeks compared to people who received a placebo. Their magnetic resonance imaging (MRI) scans also showed a favorable outcome: The volume of brain lesions lessened with Ocrevus while it increased with placebo, and Ocrevus slightly reduced the risk of shrinkage of the brain.
HC: Are there any dangerous side effects with Ocrevus?
ABZ: The most common side effects of the drug are upper respiratory tract infections, skin infections such as oral herpes, and lower respiratory tract infections, such as bronchitis or pneumonia. To date, no cases of progressive multifocal leukoencephalopathy (PML), a serious and sometimes deadly infection, have been seen with Ocrevus. (PML is a risk with some other DMTs, such as Tysabri.)
On the other hand, the drug labeling states you should not take Ocrevus if you have an active hepatitis B virus infection. There is also a risk of a reaction to the infusion, which can be serious to life-threatening; we typically give people intravenous steroids and an antihistamine like Benadryl before the drug to reduce the chances of both infusion and allergic reactions. Another potential risk is that you could develop cancer, particularly breast cancer.
You will need to have blood tests and an MRI scan before you start on Ocrevus and periodically while you’re on the drug to make sure it is working for you and isn’t causing any health problems.
HC: Is the drug affordable?
ABZ: It is quite expensive — around $65,000 a year, according to initial reports which is actually less than some other MS DMTs cost. Health insurance policies cover the drug, but you and your health care providers may have to prove you really need it. Genentech/Roche is offering financial assistance programs to help eligible patients with the out-of-pocket costs of the drug, as well as giving the drug free of charge to those who qualify.
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