Large study shows how 2 MS treatments stack up in the real world
Registry data find Ocrevus and Kesimpta offer similar disease control
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Ocrevus and Kesimpta showed high overall effectiveness with minor differences in relapse and disability control in real-world clinical data. (Photo from iStock)
- Both Ocrevus and Kesimpta provide strong disease control for people with relapsing MS in routine clinical practice.
- Real-world registry data showed that Ocrevus was associated with slightly lower annual relapse rates, while Kesimpta was linked to a slightly lower risk of disability progression.
- Researchers emphasized that these statistical differences are very small in absolute terms and that both medications remain highly equivalent and effective options for relapsing MS.
Ocrevus (ocrelizumab) and Kesimpta (ofatumumab) are both highly effective at preventing relapses and disability worsening in people with relapsing-remitting multiple sclerosis (RRMS) in real-world clinical practice, though data show small differences in their clinical profiles.
While Ocrevus was linked to fewer relapses and Kesimpta to a lower risk of disability progression, researchers noted that the differences “were significant but very small.”
“Our findings highlight the clinical equivalence of [Ocrevus] and [Kesimpta],” they wrote, adding that the observed differences between the two “should be interpreted with caution,” and that their clinical significance requires more evidence.
The study, “Comparative effectiveness of ofatumumab and ocrelizumab in relapsing multiple sclerosis: a target trial emulation using multinational registry data,” was published in the Journal of Neurology, Neurosurgery & Psychiatry.
Multiple sclerosis (MS) occurs when the immune system mistakenly attacks and damages healthy parts of the brain and spinal cord. Relapsing forms of MS, including RRMS, are marked by periods when symptoms worsen, called relapses, followed by periods of partial or complete recovery.
Comparing real-world effectiveness
Ocrevus and Kesimpta are high-efficacy disease-modifying therapies (DMTs) approved for relapsing forms of MS. Ocrevus is administered as an intravenous (into-the-vein) infusion every six months, or as a subcutaneous (under-the-skin) injection, Ocrevus Zunovo. Kesimpta is administered monthly as a subcutaneous injection.
Despite their widespread use, direct comparisons between the two treatments are limited. Previous real-world studies suggested similar effectiveness, but relatively short follow-up periods and low rates of disease events make it difficult to determine whether meaningful differences exist.
To compare the therapies in routine clinical practice, an international team analyzed real-world data from 6,572 adults with RRMS collected between 2021 and 2024 across two major registries: MSBase, a large international registry, and OFSEP, France’s national MS registry.
Overall, 2,644 participants started Kesimpta and 3,928 started Ocrevus. All had at least six months of data available before starting treatment and remained on their assigned therapy for at least six months.
Those receiving Ocrevus were slightly older, had lived with MS longer, used more prior DMTs, and had greater baseline disability, but had experienced fewer relapses than those starting Kesimpta. To make the groups more comparable across analyses, the researchers statistically matched smaller groups of patients based on their characteristics at the start of treatment.
The study’s main goals were to compare the two treatments based on the annualized relapse rate — the average number of relapses per year — and the time until the first relapse. The researchers also looked at disability-related outcomes, disease activity on MRI scans, and treatment discontinuation.
Overall, both treatments provided strong disease control, with relapses and cases of disability progression uncommon for either therapy.
While relapse rates were very low regardless, averaging 0.04 relapses per year with Ocrevus and 0.07 with Kesimpta, Ocrevus was associated with a significantly lower relapse rate. Consistent with this finding, patients taking Kesimpta had a 72% higher risk of experiencing a first relapse during follow-up than those taking Ocrevus.
In contrast, disability outcomes slightly favored Kesimpta. Patients on Kesimpta had a 34% lower risk of reaching confirmed disability progression during follow-up than those on Ocrevus.
They also had a 47% lower risk of progression independent of relapse activity, which is a gradual worsening of disability that occurs even in the absence of relapses. However, Kesimpta-treated patients were 24% less likely to experience confirmed disability improvement, or an easing of disability, than those receiving Ocrevus.
MRI findings and key takeaways
The researchers emphasized that, although statistically significant, these differences were very small in absolute terms. They suggested that while “differences in administration frequency or drug availability” in the body could have played a role, larger, longer-term studies are needed to determine the clinical significance of the study’s findings.
No significant differences were found in MRI-detected disease activity or the likelihood of stopping treatment. However, the researchers cautioned that the MRI results were highly uncertain and therefore should not be taken as proof that the two therapies are equivalent.
“In this real-world study, both [Kesimpta] and [Ocrevus] were highly effective therapies for relapsing MS but showed small differences in their clinical profiles,” the researchers wrote. “These findings may help inform future treatment selection as additional evidence emerges.”
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