Heavy-hitting MS Therapies Now Being Used Sooner for Some Patients

Ed Tobias avatar

by Ed Tobias |

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monoclonal antibodies

I’m sitting in Florida and the start of spring training is only about six weeks from now, so please forgive a baseball analogy: The heavy-hitters of the MS-fighting treatments, the monoclonal antibodies (mAbs), are moving up in the lineup.

Five treatments currently are in the mAbs class: Ocrevus, Lemtrada, Rituxan, Tysabri, and Zinbryta. (Rituxan isn’t approved as an MS treatment in the United States. Nonetheless, it’s being prescribed off-label by some neurologists.) Until recently, these mAb therapies weren’t usually prescribed as the first treatments for someone newly diagnosed with MS — one or two other disease-modifying treatments (DMT) were tried first. Two reasons appear to explain this. First, some patients and neurologists were concerned about the level of risk with these therapies. Second, some insurance companies and government health plans weren’t happy with their cost.


However, a recent audit of patients and neurologists by Spherix Global Insights, a business intelligence and market research company, reports an apparent change in attitude about cost:

“While neurologists report payers being at least somewhat restrictive during the current DMT selection process, only 28% of mAb DMT-treated patients were required to step through prior therapies before obtaining access to their current DMT. This finding suggests that payer-influenced treatment sequencing may not be a substantial barrier to increased use of mAb DMTs as induction therapy (the first treatment prescribed) in appropriate candidates.”

Risk versus benefit

A similar attitude change seems to have taken place regarding risk versus benefit. The report suggests that neurologists are increasingly prescribing certain monoclonal antibody therapies for their patients even though they may feel, as a group, that mAbs pose a risk. According to the report, neurologists believe that, for certain patients, the high-efficacy benefit of a specific mAbs made its risk “acceptable.”


In my travels around the social media world, I regularly read complaints from MS patients whose insurance, or government plan, won’t pay for one of the five monoclonal antibodies until that patient had failed two of the more conventional MS therapies. I also read about neurologists who are hesitant to prescribe mAbs, even for a patient whose disease is progressing rapidly. Hopefully, this new report is indicative of a change of attitude by doctors and by payers that will benefit those of us who fight the MS battle every day.

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


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Kara avatar


I am glad to read this. If these heavy hitting meds are more likely to lessen the long term disability, it should make sense to use them early. I wish these meds were around when I was first diagnosed. I think in the long run, they will save the insurance companies money because they won't have to pay for physical therapy and other therapies needed as disability progresses. Some of the platform, first-line MS drugs cost nearly as much as some of these drugs.

Ed Tobias avatar

Ed Tobias

Hi Kara,

I, too, wish these heavy-hitters had been around when I was diagnosed. I wish that ANY DMT had been around in 1980.

Now, I'm being treated with Lemtrada. Its price tag seems high, but not if you only need two treatments...total. And not, as you say, if you factor-in the costs of unneeded therapies. I'm not quite sure why some insurers can't understand that. At age 69, I expect Lemtrada will be my last MS drug.


Tom Harrison avatar

Tom Harrison

Wish the FDA would recognize Rituxan for MS. But Genentec would lose lots of money.

Michele Ann avatar

Michele Ann

Heavy hitting drugs , if made available back in 1996 when I was first dx, would have made a huge difference in my life (as well as others). I've been on Tysabri for 8 yrs now; but am finding myself having to consider switching to Ocrevus because I am now SPMS.

Cay Borduin avatar

Cay Borduin

Aetna will not cover Ocrevus for me! My docs appealed the refusal and lost. Aetna's reasoning was that I need tofind a few other therapies ineffective or intolerable first. Even then, they say, the contract doesn't cover Ocrevus - so tough luck.

I'm on the final therapy in the required list at this point, but jumping between meds doesn't seem to be a great idea either.


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