MS news notes: EBV vaccine trial, DMT costs, Mavenclad, evobrutinib

Columnist Ed Tobias comments on the week's top MS news

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by Ed Tobias |

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Welcome to “MS News Notes,” a Monday morning column where I comment on multiple sclerosis (MS) news stories that caught my eye last week. Here’s a look at what’s been happening:

EBV vaccine trial could start in 2024

The MS News Today story “Vaccine against Epstein-Barr virus may enter clinical trial next year” offers some news I think many of us have been waiting for.

Since January 2022, when a major research study reported a likely link between the Epstein-Barr virus (EBV) and MS, many of us in the MS community have been hoping for a vaccine that would prevent EBV, and therefore MS.

According to the latest story, “EBViously announced that it has developed a candidate vaccine against the Epstein-Barr virus and plans to bring it into clinical trials starting in 2024.” The investigational vaccine is called EBV-001, and the initial target in research is mononucleosis and the chronic fatigue it can cause.

According to Wolfgang Hammerschmidt, chief scientific officer of EBViously, “As infectious mononucleosis is a known risk factor for multiple sclerosis, there is great hope that our vaccine may also reduce the incidence of this chronic neurodegenerative autoimmune disease.”

I haven’t yet seen an indication of where the trial might be held, but let’s keep our fingers crossed that it’s successful.

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High costs associated with a trio of infusible DMTs

The conclusions reported in the story “High medical costs for MS patients starting Ocrevus, Lemtrada, Tysabri,” should come as no surprise to us. The costs are high for people with MS who are treated with these disease-modifying therapies (DMTs) delivered via infusions.

An analysis of data from commercially insured patients in the U.S. found that switching to Ocrevus (ocrelizumab), Tysabri (natalizumab), or Lemtrada (alemtuzumab) led to higher medical costs. According to the story, “the cost of medication alone accounted for more than three-quarters (78%) of the total costs.”

The analysis suggests that controlling price markups for medications could help limit healthcare costs for patients. The study also found that at-home infusions tend to be less expensive than infusions at a hospital or a physician’s office.

I was treated with Tysabri and Lemtrada and am glad I had good insurance to cover the costs. But when I switched from commercial insurance to Medicare, I discovered that my out-of-pocket costs were actually less than when I was treated with Aubagio (teriflunomide), a pill. That’s because 80% of the costs of the infusions of the previously mentioned DMTs were covered by Medicare Part B, and the pill was covered under Part D. Though the price of Aubagio was lower, its out-of-pocket costs were higher for me. Of course, not everyone’s situation is the same, but this was my experience.

Sustained benefits seen with Mavenclad

Before I started treatment with Lemtrada in December 2016, I was told that after two treatments, it would be my final MS DMT. That’s been the case even though my MS has continued to slowly progress. I think the Lemtrada treatments slowed my progression, even though they failed to stop it.

Now, as reported in “Mavenclad benefits for MS sustained up to 15 years after last treatment,” a real-world data study says the benefits of Mavenclad (cladribine) were sustained for up to 15 years after its last treatment course in people with relapsing MS. More than half of those treated in the clinical trials that supported its approval needed no further DMTs. That’s certainly encouraging news.

Liver enzyme issues in evobrutinib trials

A little over a month ago, MS News Today reported that a Phase 2 trial of evobrutinib had produced some encouraging data: It was well tolerated and had shown low relapse rates after four years of treatment. Now, the story “FDA puts partial hold on trials of Merck KGaA’s evobrutinib in MS” reports that two patients in Phase 3 clinical trials of evobrutinib “were found to have elevations in their liver enzymes.”

Two other BTK inhibitors, tolebrutinib and orelabrutinib, have also had their trials placed on partial hold.

I hope this is just a minor setback for this type of treatment. Back in July 2021, I wondered if BTK inhibitors could be the next big MS treatment. I still hope they can be. Time will tell.

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.


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