Multiple sclerosis (MS) patients are largely moving away from injectable drugs and towards oral treatments when they switch from first to second-line MS therapies. But that might change with the introduction of Ocrevus (ocrelizumab), which has become the drug of choice for many neurologists advising patients on drug switches.

The real-world analysis by Spherix Global Insights suggests that Ocrevus is challenging other disease-modifying treatments for relapsing MS.

In an overview of patient medical records, Spherix — in collaboration with their neurologists — assessed the treatment choices of more than 2,000 MS patients. The group consisted of 1,020 patients who were receiving their first MS therapy, and 1,002 patients who were switching treatments.

The data showed that doctors are increasingly prescribing oral drugs such as Sanofi-Genyzme‘s Aubagio (teriflunomide), Novartis‘ Gilenya (fingolimod) and Biogen‘s Tecfidera (dimethyl fumarate) for patients as a first-line treatment. In addition, neurologists at MS specialty centers and those who cannot offer patients infusion therapy are more likely to prescribe oral MS treatments as a first treatment option.

The analysis also showed that patients who start oral disease-modifying therapy usually have higher disability scores as measured by the Expanded Disability Status Scale, compared to those who start so-called platform injectables such as interferons and Teva’s Copaxone as first-line treatment.

Although data showed that Copaxone (glatiramer acetate) is still one of the most widely prescribed first-line drugs, doctors are increasingly prescribing the competitor injectable glatiramer acetate — Sandoz‘s Glatopa, with insurance coverage being a major contributing factor for this.

But MS patients are switching treatments faster than ever. Neurologists report about 30 percent of patients change treatments each year. Among the 1,002 switch patients analyzed, most were moving from their first to their second treatment. Most moved away from platform injectables during the shift.

In the switch report, Spherix noted that infusion treatments or monoclonal antibodies become more prominent with every treatment switch.

These drugs — such as Biogen’s Tysabri (natalizumab), Sanofi-Genyzme’s Lemtrada (alemtuzumab), Genentech‘s Rituxan (rituximab) or AbbVie/Biogen’s Zinbryta (daclizumab) — only make up about 10 percent of first-line treatment. But as patients move towards their third treatment, more than 25 percent choose an infusion.

A switch to an infusion treatment could be linked to higher disease activity; 43 percent of infusion-switchers experienced a relapse. More than one-third of patients had increasing brain lesion burden, and 18 percent had an increase in brain tissue loss since their previous neurologist visit.

For primary progressive MS patients, Ocrevus is currently the only approved treatment, and is the drug of choice for many. Neurologists predicted  that Ocrevus would become the next drug for about 20 percent of their relapsing MS patients, should their current treatment prove insufficient.

Spherix, based in Exton, Pennsylvania, will offer the first analysis of U.S. Ocrevus use in its June release of RealTime Dynamix. The company’s analyses offer a more nuanced picture of treatment and related behavior than claims data, since it works with neurologists to gather information.

• Author Details

Patricia Silva, PhD

Patrícia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites.

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Patricia Silva, PhD

Patrícia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites.