Ocrevus Climbing as First-line DMT for RRMS Among Neurologists Surveyed in Spherix Report

Eighteen months after its entrance into the U.S. market, Genentech’s Ocrevus (ocrelizumab) has become the monoclonal antibody of choice to treat patients with multiple sclerosis (MS), according to a survey of nearly 100 neurologists across the U.S.

Self-reported use of Ocrevus for the third quarter of 2018 surpassed Biogen’s Tysabri (natalizumab) in this class of MS therapies for a first time, exceeding neurologists’ expectations of six months ago by 7.4 percent for this quarter, it reports.

Spherix Global Insights, the independent market research company that conducts quarterly analyses of MS treatments and their use, suggests in a press release that a factor in this “dominance” may be Genentech’s efforts to promote earlier use of Ocrevus among patients with relapsing-remitting MS (RRMS).

A related factor, noted in the survey, is Ocrevus prescribers reporting that “significantly more” of their RRMS patients are now using this medication as their first disease-modifying therapy (DMT) compared to one year ago. The neurologists also report being much more comfortable using Ocrevus as first-line therapy for relapsing forms of MS this year, and much likely to consider their RRMS patients as suitable Ocrevus candidates.

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The report, “RealTime Dynamix: Multiple Sclerosis (US),” looked into trends regarding DMT use through an online survey of 99 clinical neurologists who are part of the Spherix Network. It also assessed how product perceptions, disease awareness and attitudes, practice management, as well as certain beliefs, influence MS treatment choices in the U.S.

High-efficacy DMTs like Ocrevus, Tysabri, and Novartis’ Gilenya (fingolimod) are more likely to be prescribed as first-line treatments for newly diagnosed patients with poorer prognostic profiles (aggressive or active disease), the report notes, and indeed it found that RRMS patients with these criteria were more likely to be started on one of these three treatments.

But other patients were as well.

“Interestingly, the prescriber bases of neurologists who initiated Ocrevus as RRMS patients’ first-line DMT were similar regardless of prognostic profile, suggesting a willingness among a subset of neurologists to consider the agent as one of their standard first-line choices,” the Spherix release states. “Ocrevus first-line use in patients without concerning prognostic profiles would compete directly with the oral DMTs (i.e., Biogen’s Tecfidera) and the GA [glatiramer acetate] agents (i.e., Teva’s Copaxone) .”

Spherix’s survey was less optimistic for EMD Serono‘s Mavenclad (cladribine tablets) — now under FDA review for possible approval — because of uncertainty in the level of medical interest. Those following it were interested in a “high-potency DMT with a convenient oral dosing schedule,” while others with less interest were focused on safety concerns. “Neurologists remain split on the relevancy of Mavenclad,” the release staes.

Continued concern over how best to treat secondary progressive MS (SPMS) patients keeps interest among DMTs in development focused on Novartis’ siponimod, a potential oral once-daily treatment  also up for FDA review. However, interest has declined over the last two quarters, Spherix noted, with only 24 percent of survey respondents said to be “eagerly awaiting siponimod approval” by the FDA.

Although recent clinical data show that siponimod can reduce the risk of disability progression in patients with non-relapsing MS, less than one-third of the neurologists thought it appropriate for SPMS patients without inflammatory activity.

But, the release also notes, “compared to active SPMS, not active SPMS represents a greater opportunity due to its larger untreated patient pool ─ a group that would be receptive to a disability risk reduction message” from Novartis and key to the company “for fully realizing the DMT’s market potential.”