Will Reduced Treatment Time Keep Ocrevus Competitive?

Will Reduced Treatment Time Keep Ocrevus Competitive?
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One of the key considerations when choosing a disease-modifying therapy (DMT) is how much it will disrupt your life. It’s one of several factors that need to be evaluated.

Unlike shots and pills, infusion treatments can require a significant amount of time. That’s why the U.S. Federal Drug Administration’s December approval of a shortened infusion time for Ocrevus (ocrelizumab) can be a big deal for people with MS.

MS infusion times vary

There are currently three infusions approved in the U.S. to treat MS. One is Tysabri (natalizumab), which requires about two hours in an infusion chair each month. Half that time is the actual infusion, while the other half is for observation.

Another of these DMTs is Lemtrada (alemtuzumab), which has a complicated protocol of up to eight hours of total chair time, including administering pre-medications, followed by four hours to administer the DMT, and then time for observation. This is repeated for five consecutive days. Three of those days are repeated a year later, and sometimes a third three-day course is needed.

The infusion time for Ocrevus used to be three and a half hours, with a total treatment time of about five and a half hours. Now, the time of the actual infusion has been reduced to two hours, dropping total treatment time to about four hours. (The original infusion time remains the same for the first two treatments, however, which are scheduled only two weeks apart.)

That’s about half the treatment time of Lemtrada, but Ocrevus requires a return treatment every six months.

Which one is for you?

Efficacy and possible side effects aside, which of these three DMTs fits your lifestyle? Apparently, it’s Ocrevus for many people.

A report from Spherix Global Insights lists Ocrevus as the most prescribed treatment in the U.S. for people with progressive forms of multiple sclerosis, prescribing it for nearly 60% of those patients, according to doctors surveyed. But the Spherix report warns that Ocrevus is being challenged by a newer DMT, Mayzent (siponimod). And Mayzent is a once-a-day pill. Lifestyle-wise, pills are winners.

DMT choice is always a balance to weigh the efficacy of a medication with its risks, along with lifestyle demands and cost. Does one of these therapies appeal to you more than the others? If so, which? And what affected your decision the most? Please share in the comments below.

My usual “MS News That Caught My Eye” column will return next Monday. You’re invited to visit my personal blog at www.themswire.com.

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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Diagnosed with MS at age 32 in 1980, Ed has written the “MS Wire” column for Multiple Sclerosis News Today since August 2016. He presents timely information on MS, blended with personal experiences. Before retiring from full-time work in 2012, Tobias spent more than four decades in broadcast and on-line newsrooms as a manager, reporter, and radio news anchor. He’s won several national broadcast awards. As an MS patient communicator, Ed consults with healthcare and social media companies. He’s the author of “We’re Not Drunk, We Have MS: A tool kit for people living with multiple sclerosis.” Ed and his wife split time between the Washington, D.C. suburbs and Florida’s Gulf Coast.
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Diagnosed with MS at age 32 in 1980, Ed has written the “MS Wire” column for Multiple Sclerosis News Today since August 2016. He presents timely information on MS, blended with personal experiences. Before retiring from full-time work in 2012, Tobias spent more than four decades in broadcast and on-line newsrooms as a manager, reporter, and radio news anchor. He’s won several national broadcast awards. As an MS patient communicator, Ed consults with healthcare and social media companies. He’s the author of “We’re Not Drunk, We Have MS: A tool kit for people living with multiple sclerosis.” Ed and his wife split time between the Washington, D.C. suburbs and Florida’s Gulf Coast.

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15 comments

  1. I have been living with MS since 2003. My first treatment was the initial study for Lemtrada (during the study is was called Campath), this was a yearly infusion that had some side effects that resolved for me after a few weeks, after the study I have tried the injections and pills (tecfidera) both which the side effects for me were not worth the treatment. Now currently on ocrevus and have been for past 3 years, no problems with ocrevus and no relapses for past 2 years. Excited that the infusion time decreased but 2 times a year is manageable. Easier for me as I am not a good pill taker because I forget to take it and forget if I took it or not 🙂

    • Ed Tobias says:

      Thanks for your comments, Teri.

      You’re fortunate to have been treated with two of the most effective DMTs right away. The injections and pills, from everything I know, can’t match the efficacy of the infusions. Also, many top MS neurologists believe the best way to treat MS is to hit it fast and hit it hard.

      Good luck to you and I hope your new year is COVID-free.

      Ed

  2. Irene Jacobson says:

    I was diagnosed with MS in 2003 after over 20 years of misdiagnoses for my many (typical) MS symptoms. I was on Betaseron and Extavia for 14 years, which worked well even with my very busy work travel. But I started to have side effects after 14 years and switched to Ocrevus. I too have done well with the treatment with even a little improvement in my MS. I am now retired so two days a year to schedule around is not too difficult. Injections did not bother me, but it was a lot to carry around all the time. Pills would be okay as I create weekly pill packs and I only forget to take pills maybe once or twice a year at most. But I am happy with Ocrevus and do not see any reason to switch at this time.

  3. Nathalie says:

    I was diagnosed with RRMS about 3.5 years ago and was on Tysabri for the first 7-8 months to try to bring things under control. The 1x a month infusion was effective but hard to deal with psychologically due to JC+ status and the constant fear of PML. Switching over to Ocrevus was a big leap forward. It has been super-effective, with some fatigue around infusions but overall – really quite manageable. Currently playing around with infusion intervals; some studies show (and my personal case attests) that a longer window than 1x every 6 months for the treatment is quite doable provided specific lymphocyte markers show one is still below average ranges. No guarantees of course, but life is a gamble and I am a big believer in exploring what works for one’s own body. So far so good; I am grateful to the makers of Ocrevus. But I personally will not take it according to their protocol; I don’t think they leave any room at all for the regenerative capabilities of our bodies. It has been over 12 months out since last infusion and I will wait another month or two before sitting for another one. I am lucky my neuro grudgingly allows for this. I have had no episodes/flares since diagnosis and last MRI results show that some lesions have even all but disappeared. Gradually, I will unravel the storm of MS on my own terms and reverse this condition. Til then, ocrevus is a great support.

    • Ed Tobias says:

      Nathalie,

      I’m glad that Ocrevus is working well for you. Just remember, they don’t decide on the protocol on a whim. There’s a reason they chose a six month treatment gap. Ocrevus is designed to keep your B-cells suppressed and six months is the period of time after which they usually return to a normal level. It’s your body, of course, but please keep in mind that there may be progression that doesn’t show up as a flare or on an MRI.

      Best of luck,

      Ed

  4. Anthony H says:

    I’ve been on Ocrevus around two years now. Funnily, the longer infusion time didn’t bother me as much as the shorter time. I think it is the same amount of fluid dripping in at a faster rate, and in my case it seems to go straight to my bladder, so I don’t want it all at once.

    Last time I had bladder urgency during the infusion. It seemed for one stretch I was continually getting up to go to the bathroom with the infusion stand in tow. Add to this I am a disabled walker – at the least I need a crutch to support me and a helping hand or wall to steady me (or a walking frame). I needed to ask a nurse to help me several times in quick succession.

    I have asked my neurologist about switching to siponimod. He wants to stay with Ocrevus, but I think I will keep asking in future.

    • Ed Tobias says:

      Hi Anthony,

      When I was receiving my Lemtrada infusions I constantly needed to urinate. Thank goodness for portable urinals…no need to stumble to the bathroom.

      Ed

  5. Justina C. Potter says:

    I have been on Ocrevus for almost 3 years. Doing an infusion twice a year was the main game changer for me. I was doing self injections 3 times a week, for 10 years. During that time, my treatments were always on my mind. Also, it was beginning to affect my injection spots. Now, I go twice a year, and can kind of forget about it for a while. Taking 2 days out of a year for infusion is no problem. I even look forward to it, because I get to rest during the treatment, which is a rare thing otherwise.

    • Ed Tobias says:

      Hi Justina,

      I was in the Phase III trial of Avonex back in the late 1990s and was then using it for several years. Eventually, I developed needle fatigue and those those shots were only once a week. I felt the same way as you about infusions when I was receiving Tysabri once a week but my long series of Lemtrada infusions was far from restful.

      Ed

  6. WheatonMama says:

    Ed, I continue to be amazed by the belief that people think they are majorly inconvenienced by the long Ocrevus infusion times. I am more likely to believe that infusion centers don’t like having their chairs tied up for a whole day and are asking for shorter infusion times. Quicker turn-around times for chairs mean more $$ for the provider!

    I have been on O for the last 3 years and I don’t think the long infusion time is a big deal. It’s like 2 guaranteed vacation days for me each year and much less inconvenient than remembering a pill each day.

    • Ed Tobias says:

      I felt the same way about “vacation” time when I was getting a monthly Tysabri infusion. My Lemtrada infusions, on the other hand, were much more like work.

      I’m not sure about your belief about the infusion centers, however. It’s hard for me to think that chopping 1.5 hours from an infusion that already takes most of a day will improve turn-around times the way a restaurant tries to turn over its tables to improve its profits.

      Ed

  7. Catherine says:

    Hello, I am in the UK, rely on the NHS for treatment and have had MS for 21 years. Initially I was told to ‘wait and see what happens’. After 7 years of that (and 3 relapses), I was given my first DMT, which was Avonex. I was sort of okay with the injections, as it is only once a week. However the side-effects were pretty bad. Saying they are ‘flu-like’ doesn’t really cover it. But I persevered, because there didn’t appear to be anything else at the time. Gradually my body got used to the side-effects, but I kept looking out for alternatives. As soon as I saw there were oral DMT’s available, I began to nag my Neurologist for one of these. At each consultation I was battered away with the line ‘but you are doing so well on Avonex’. Eventually after several years of this (and 10 years of weekly injections), I was put on Tysabri. This worked really well for me for 3 years until my lymphocyte count dropped, and I was taken off of it. Two options were offered to me; Brabio (a 3 times a week injection) or a return to Avonex. I refused both and just kept on asking for something more effective. After taking nothing for a year (a bit of a risk I think), I was finally offered Ocrevus. I had my first two half infusions earlier this year, and already feel I can think more clearly and even walk a bit farther and for longer. I wanted Ocrevus because 1. it’s not an injection 2. the side-effects are manageable but most important 3. it is one of the more effective DMT’s available. I have had to fight all the way for where I am today. Having different Neurologists over the years (I am on my 11th now) hasn’t helped, as they can’t see how I have declined over the years (how many consultants take the time to go back through a patient’s notes and read them properly?). I hope others get the DMT of their choice, and don’t have to fight for it like I have. If you do have a fight on your hands, don’t give up! Exhausting as it has been, I am so glad I kept on asking (begging sometimes!) and got what I wanted in the end.

    • Ed Tobias says:

      Hello Catherine,

      Thanks for sharing your MS journey with us. Far too many neurologists fail to take into account that there are several things to take into account when deciding on a treatment. Lifestyle and cost (for those not on a national system) are just as important as efficacy.

      As for “but Avonex is working so well for you” I’d respond, “maybe, but I want something that will work better.”

      You’re right…keep pushing for what’s best for you. I’m glad you’re now being treated with Ocrevus. A lot of people report they’re doing very well on it.

      Ed

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