Ocrevus Limits Progression Equally in Black, White People With RRMS

Ocrevus (ocrelizumab) seems to be equally effective at stabilizing disease activity in Black and white patients with relapsing-remitting multiple sclerosis (RRMS), a U.S. study found.

Disability levels and MRI disease markers remained generally unchanged over the two-year study in both groups, despite Black patients having more severe disability at its start.

“Prospective studies are needed, and ongoing, to extend these findings,” the researchers wrote, noting that such studies also aim to better understand the mechanisms underlying the “disparity in disease manifestation” between Black and white patients.

The study, “Effectiveness of Ocrelizumab on Clinical and MRI Outcome Measures in Multiple Sclerosis across Caucasian and African Ancestry Cohorts: A Single-center Retrospective Study,” was published in Multiple Sclerosis and Related Disorders.

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Little change seen in EDSS scores over two years of Ocrevus treatment

Historically, multiple sclerosis (MS) was thought to be significantly more prevalent among Caucasians than other ethnic groups. But recent evidence suggests that MS may be underreported among minorities, especially in Black communities. Reasons for this could be related to barriers to medical care affecting these communities disproportionately.

Data also indicate that Black people with MS tend to have a more severe disease course than white patients. This includes an earlier age at disease onset, poorer recovery from relapses, faster disease progression, more inflammatory brain lesions, and greater brain atrophy (shrinkage).

“Despite a more aggressive disease course, Black patients are underrepresented in most MS clinical trials, making up less than 5% of participants, including the Phase III trials” of Ocrevus, an approved B-cell depleting therapy for MS, the researchers wrote.

To investigate whether responses to Ocrevus differed between Black and white patients, researchers at universities in Wisconsin and Illinois retrospectively reviewed medical records from RRMS patients given this treatment in a real-world setting from August 2017 to May 2021.

Records retrieved from the University of Chicago MS Database covered 229 patients, 83 (36%) of whom self-identified as Black. The other 146 people identified as white.

A number of baseline characteristics differed between these two groups. Specifically, a significantly greater proportion of Black patients were women (78% vs. 62%), and Black patients tended to be younger (median age of 45.4 vs. 49).

Black patients also had significantly lower vitamin D levels, which is linked with worse disease outcomes, and higher scores on the Expanded Disability Status Scale (EDSS), reflecting a greater degree of MS-associated disability.

The study’s main goal was to assess changes in EDSS scores with Ocrevus’ use. A clinical assessment was performed at the study’s start (baseline) and again after one and two years of treatment.

In general, EDSS scores remained relatively stable over the study’s course, in line with previous clinical trials of Ocrevus. Notably, race did not have a significant effect on EDSS changes over time, regardless of Black patients starting with higher EDSS scores (median baseline EDSS of 4 for Black patients and 2.5 for white patients).

“Ocrelizumab [Ocrevus] treatment effect on EDSS stability over time was consistent,” the researchers wrote.

A subset of 48 patients, 35% of whom were Black, had available MRI scans collected throughout the study period, including measures of brain atrophy and lesion load.

MRI markers of disease progression also did not change significantly over a median of almost two years, with no differences observed between Black and white patients.

“Given the worse disease trajectory for Black MS patients described in prior studies, the results of our study show that an anti-B cell therapy is an effective treatment for this cohort of patients,” the researchers wrote, noting the “importance of starting this agent early in the disease process.”

Characteristics of this study’s two patients groups “are generally in keeping with prior published data, validating the results herein and implying generalizability,” they added.