MS News Notes: ECTRIMS, Ocrevus, Kesimpta, Epstein-Barr, DMTs

Here are a few multiple sclerosis (MS) stories that caught my eye last week. Two of them came out of this year’s Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS).

Ocrevus treatment

More than 250,000 people with MS have been treated with the disease-modifying therapy (DMT) Ocrevus (ocrelizumab) since its approval by the U.S. Food and Drug Administration in 2017. Clinical trials have reported that it reduces the rate of MS relapses and eases disability.

The MS News Today story titled “#ECTRIMS2022 – 2-year Ocrevus Effective for Early MS Patients: Data” reports that if treatment with Ocrevus is started in the earliest stages of the disease, even better outcomes and long-term clinical benefits may result. I’m a believer in the hit-it-fast-and-hard theory of MS treatment, and this story reinforces my thoughts on the matter.

Nearly 80% of people with early-stage relapsing-remitting multiple sclerosis (RRMS) show no evidence of disease activity after two years of treatment with Ocrevus according to updated data from the ENSEMBLE Phase 3b trial.

More than 88% of the patients were negative for MRI activity, meaning they had no new or enlarging lesions or lesions with active inflammation. Over 90% also had no relapses or confirmed disability progression at two years.

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#ECTRIMS2022 – Genetic Variants Tied to Worse MS ID’d in New Study

Ofatumumab injection vs. IV

I was surprised by the story “IV Ofatumumab Reduces Relapses in MS, But Not Better Than Kesimpta.” Though my nonmedical logic tells me that an IV treatment of a medication should work better than an injected one, this study reports otherwise.

It also notes that patients treated with off-label, IV-administered ofatumumab experienced more infusion-related reactions than those treated with other IV-administered, anti-CD20 medications. The case for Kesimpta, which is the brand name of ofatumumab and is administered subcutaneously, was strengthened when, as reported in September in MS News Today, an analysis showed Kesimpta was more cost-effective than most other DMTs. It seems as if it’s a treatment worth discussing with your neurologist.

An intravenous (into-the-vein) formulation of ofatumumab — a disease-modifying therapy for multiple sclerosis sold under the brand name Kesimpta — resulted in a 63% reduction in relapse rates among MS patients, with about 60% remaining relapse-free over the first year of treatment, a recent study in Denmark found.

However, relapse reduction with this formulation was inferior to that seen with the approved formulation of Kesimpta, which is administered subcutaneously, or under the skin.

Another EBV-MS connection

Another story from ECTRIMS adds yet more evidence to support the theory that if scientists can cure the Epstein-Barr virus (EBV), then they have a good shot at curing MS. In this report, “#ECTRIMS2022 – EBV Antibodies Precede Early Nerve Damage Signs,” researcher Daniel Jons, of the University of Gothenburg, Sweden, argues that the presence of EBV antibodies before the appearance of MS “strengthens the theory of EBV infection as a possibly necessary condition for MS development.”

An infection with the Epstein-Barr virus consistently preceded elevations in neurofilament light chain (NfL), an early biomarker of nerve cell damage, in people who went on to develop multiple sclerosis, new data show.

An increase in NfL levels, which is thought to occur before the clinical emergence of MS, was observed about 5–10 years before the onset of disease, whereas antibodies against EBV were detected at high levels as early as 10–15 years before onset. NfL elevations were never detected among the few pre-MS individuals who didn’t develop EBV antibodies.

Stopping a DMT could be risky

There are many reasons why someone might stop receiving a disease-modifying therapy — side effects, lack of efficacy, issues with health insurance coverage, changes in life circumstances such as pregnancy, and more. However, there is little published data on how MS tends to progress after a patient discontinues a DMT.

In “Risk of MS Activity After DMT Stop Greater With RRMS, Younger Age,” Marisa Wexler reports on an analysis of data from 377 people with MS who had been on a DMT for at least two years and then stopped for at least six months. The researchers found “after discontinuation, the presence of relapse was detected in 18.8% and 3.5% in RRMS and SPMS, respectively; and new MRI activity in 22% and 3.5%, respectively.” And the increases were most evident with men younger than 45.

When multiple sclerosis patients stop their disease-modifying treatment, the risk of relapses and disease activity on MRI scans is higher among patients who are younger, have a shorter duration of disease, and have relapsing-remitting MS, a study from Argentina reports.

Male sex and a relapse in the past six months also linked with a greater risk of MRI activity.

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