MS Therapies: What’s Hot, What’s Not

Ocvevus (ocrelizumab) is off to a running start, Tecfidera (dimethyl fumarate) leads the pills and the four injectable multiple sclerosis drugs are being used by fewer MS patients. But Copaxone (glatiramer acetate injection) remains the leader of the pack of the disease-modifying therapies.

Those are some of the headlines from a recent report from Spherix Global Insights, a business intelligence and market research company that looks at drug trends every quarter. The sample size is small, with only about 100 neurologists answering an online survey, but it seems to do a good job of looking at the way disease-modifying drug use is trending.

The big three DMDs

The top disease-modifying drug, or DMD, continues to be Copaxone, a drug that’s injected either once a day or three times a week, depending on dosage strength. Copaxone has been around since 1996. Just more than 20 percent of the neurologists in the survey are prescribing it for patients. That’s followed by Tecfidera, a twice-daily pill (15 percent are prescribing) and Avonex (interferon beta-1a), another injection that was approved in the late 1990s (9.5 percent).

The trend, however, is toward change. Seventy-eight percent of the neurologists surveyed reported that during the past three months they had changed the drugs they were prescribing for some of their patients. The major changes were moving patients to Ocrevus (32 percent) or increasing the use of oral drugs, such as Aubagio (teriflunomide), 16 percent. Analysts at Spherix expect the use of Copaxone, Tecfidera and Avonex will fall by the time of their next quarterly report.

Ocrevus

The big star of this report is Ocrevus.

Within a month of the drug’s launch, nearly half of the neurologists surveyed reported they had some of their MS patients using Ocrevus. Most of these patients were switched from another DMT, usually Tysabri (natalizumab) or Rituxan (rituxumab). But a sizable number were using no DMT before Ocrevus. That, according to the analysts, suggests some doctors had waited for Ocrevus to be approved by the U.S. Food and Drug Administration rather than starting a patient on a different drug and then switching.

Fifty-four percent of the patients for whom Ocrevus was prescribed had a diagnosis of relapsing MS, 31 percent were primary progressive, and 15 percent were secondary progressive. Analysts predict that, by their next report, Ocrevus use will jump from the current 1.5 percent to 5.8 percent of patients.

Here’s why:

Ocrevus vs. Tysabri

Ocrevus is seen as a big challenge to Tysabri. Both are infusions. The majority of the neurologists surveyed thought Ocrevus was more effective at halting MS progression than Tysabri. They also believed it carried less risk for the brain disease PML and that was more convenient for their patients. (Ocrevus is administered twice yearly, Tysabri is monthly).

On the other hand, Tysabri had the upper hand in terms of familiarity and comfort level for doctors and their staffs, and doctors said they saw fewer infusion reactions with it.

Ocrevus vs. Lemtrada

Only 3 percent of neurologists in the survey reported they had treated patients with Lemtrada (alemtuzumab) during the quarter. The neuros surveyed thought Ocrevus is more effective than Lemtrada for PPMS patients. (Ocrevus is the only FDA-approved DMD for progressive MS). On the other hand, the neuros gave a slight edge to the effectiveness of Lemtrada for RMS patients. Ocrevus was reported to be better tolerated by patients who had fewer infusion reactions. The comfort level of doctors and staff also was reported to be better with it.

What if you could choose only three?

When neurologists were asked which DMDs they would choose for their patients if they had only three from which to choose, the doctors were partial to “old reliables.” Copaxone, Tecfidera and Tysabri topped the list. Ocrevus came in fourth. But the doctors reported that 18 percent of patients are asking to be put on a specific drug, and they’re asking for Tecfidera, Gilenya (fingolimod), and Ocrevus.

The future

Forty-five percent of the neurologists surveyed report they’re using Ocrevus now. Seventy-nine percent said they planned to start using it. Aubagio, Lemtrada and Zinbryta (daclizumab) also are expected to see increased use.

Treatment goals and hurdles

There’s a lot more interesting information in the Spherix report, including what doctors say they want in a DMD, what goals they identify for patient treatment and what hurdles patients face getting insurers to pay for DMDs. I’ll take a look at these subjects in an upcoming column.

(You’re invited to follow my personal blog at www.themswire.com)

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