Ocrevus, fampridine improve walking ability in MS: Review
Data show 'preliminary evidence' Ocrevus may ease walking impairment
Fampridine, which is approved to improve walking in people with multiple sclerosis (MS), and the disease-modifying therapy Ocrevus (ocrelizumab) seem to have the greatest benefits on MS walking abilities, according to a systematic review and meta-analysis of treatment options.
The data align with previous findings for fampridine, which is sold as Ampyra in the U.S. and Fampyra in other countries, with generic formulations also available. But the findings also show “preliminary evidence that [Ocrevus] may have the potential to improve [walking] impairment in MS,” researchers wrote.
The study, “Estimating treatment effect on timed 25-foot walk in multiple sclerosis: A systematic review and meta-analysis,” was published in Multiple Sclerosis and Related Disorders.
MS is a neurodegenerative disease that causes a wide range of symptoms, including movement problems such as walking and balance difficulties and frequent stumbles that tend to become worse over time.
Evaluating treatment effects on walking
The 25-foot timed walk (T25FW) test, which measures how fast a person can walk 25 feet, is commonly used to assess mobility and determine the extent of walking impairments in people with MS. It is often included in clinical trials assessing new therapies or rehabilitation approaches, and is considered a reliable measure of walking impairment.
However, “there is a lack of evidence evaluating the treatment effects on T25FW in MS,” and it’s unclear whether there are disease-modifying treatments (DMTs) or other therapies for managing MS symptoms that can improve walking in these patients, the researchers wrote.
The researchers conducted a systematic review of published studies and examined their data together to determine which MS treatments had a significant impact on walking function.
The team, in Korea, looked for clinical trials or observational studies that reported the effects of treatment on T25W. They identified 21 parallel-arm studies, which compared the effects of two different interventions, as well as 20 single-arm studies, which assessed a single therapy.
In total, 18 different drugs were included in the analysis, including six DMTs: glatiramer acetate (sold as Copaxone, among others), interferon beta-1a medications, Gilenya (fingolimod), Mayzent (siponimod), Ocrevus, and Tysabri (natalizumab). The remaining treatments included drugs such as fampridine and baclofen, which is used to reduce muscle stiffness, and certain experimental therapies.
In parallel-arm studies, patients in the active treatment groups were 28% more likely to experience a significant improvement in T25W performance. In one study comparing Ocrevus against a placebo, the treatment increased the likelihood of a walking improvement by 60%, but no significant differences were observed for other DMTs.
Fampridine, also known as dalfampridine, was associated with better performance in one study, with patients being three times more likely to have T25W improvements. Still, when all fampridine studies were analyzed together, there was no significant benefit from treatment.
In single-arm studies, the combined effect of nine treatments analyzed demonstrated a significant improvement in walking abilities in the T25W test. Fampridine, which was examined in 10 studies, resulted in the greatest mobility improvement.
The researchers said the study “reaffirmed that fampridine, the most common treatment for ambulatory impairments, showed a significant longitudinal effect in improving ambulatory ability, aligning with the recommended clinical guidelines.”
The fact that Ocrevus also significantly improved walking suggests “that DMT could play a role in addressing these impairments alongside symptomatic treatment,” they concluded.
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