Lemtrada (alemtuzumab) may be more effective in preventing relapses in multiple sclerosis patients than the newly approved Ocrevus (ocrelizumab), according to a study presented April 28 at the American Academy of Neurology (AAN) 2017 Annual Meeting in Boston.
The study, supported by Sanofi Genzyme and Bayer HealthCare Pharmaceuticals, compared the two drugs using an analysis of how many patients are needed to treat to prevent one additional bad outcome. This type of analysis, called “number needed to treat” (NNT), allows comparisons of drugs in the absence of trials that compare different drugs side by side.
Although Lemtrada is more efficient, researchers from Italy’s Vita-Salute San Raffaele University concluded, only real-life data could confirm their findings. The study is based on several previous clinical trials, including patients treated for two years with 12 mg of Lemtrada in the Phase 2 CAMMS223 trial (NCT00050778), Phase 3 CARE-MS I (NCT00530348), and Phase 3 CARE-MS II (NCT00548405). Those in the second CARE-MS study were 628 patients who had not responded to an earlier treatment.
The groups differed in how long they had been ill and how disabled they were. Expanded Disability Status Scale (EDSS) scores were somewhat lower among Lemtrada patients. The duration of disease was also longer in the Ocrevus-treated groups — 6.7 years compared to 1.9 years in CAMMS223 and CARE-MS I and 4.5 years in CARE-MS II.
Both Lemtrada and Ocrevus had been compared to interferon-beta 1a in the trials, and researchers used information of how the drugs differed in absolute risk for relapses and disability to interferon to compute NNT. In fact, they found NNT to be lower in Lemtrada patients than among those treated with Ocrevus.
For relapses, NNT was 5 in the combined CAMMS223 and CARE-MS I trials, 4 in the CARE-MS II study, and 8 in both OPERA studies. In addition, NNT to prevent disability progression waslower with Lemtrada. This indicates that Lemtrada more effectively prevented relapses and disability progression than Ocrevus, but researchers stressed that real-life experience is needed to confirm the findings.