Ocrevus Use Rises Among New Starters with RRMS, Loses Ground to Other Therapies in PPMS

First-line use of Genentech‘s Ocrevus (ocrelizumab) for patients with multiple sclerosis (MS) has remained stable through 2019 compared to 2018, according to the latest Spherix Global Insights‘ report.

However, the latest edition of “RealWorld Dynamix: DMT New Starts in Multiple Sclerosis (US),” based on 1,006 charts of MS patients prescribed their first disease-modifying therapy (DMT), confirms that Ocrevus prescriptions still lag behind other first-line medications, including Teva‘s Copaxone (glatiramer acetate), Biogen‘s Tecfidera (dimethyl fumarate), Mylan‘s generic glatiramer acetate, and Novartis‘ Gilenya (fingolimod).

In turn, Ocrevus use as treatment starter almost doubled among relapsing-remitting MS (RRMS) patients, while falling by half among primary progressive MS (PPMS) patients, equalling out its overall use.

According to a Spherix press release about the report, neurologists now are more willing and comfortable to prescribe Ocrevus as a first-line treatment for relapsing MS forms than they were in 2018, suggesting a shift toward earlier use of the medicine.

The data showed that 58% of the surveyed neurologists feeling more confident about Ocrevus’ early use prescribed it to 10-times more new-start relapsing MS patients, compared to neurologists who were not as comfortable with its initial use as a first-line treatment.

In comparison, the use of both Tecfidera and Tysabri (natalizumab, marketed by Biogen) subsided over the past years among RRMS patients — most likely because Ocrevus is presented as a viable first-line alternative. Gilenya prescriptions remained stable, supported by its once-daily oral administration, and balanced efficacy and tolerability.

Of note, according to Spherix, most neurologists believe that over the past year they used oral DMTs more frequently as first-line therapy, however, the company’s reports indicate that the oral DMT class share has remained flat since 2016.

Among PPMS patients starting treatment for the first time, Ocrevus remains the leading choice, with a larger proportion of patients using it compared to three years ago. This is likely aided by Ocrevus’s unique label to PPMS (Ocrevus is the first medication approved for PPMS), as well as revisions to the McDonald’s MS diagnostic criteria.

However, in the past two years, Ocrevus has lost significant ground to off-label use of glatiramer acetate, in particular to generics, due to tolerability concerns and pressure from payers.

Those trends are sustained by another 2019 Spherix report, “RealWorld Dynamix: Progressive Forms of Multiple Sclerosis (US),” which recorded up to twice as many first-line glatiramer acetate prescriptions among PPMS patients, compared to Ocrevus.

According to the report, PPMS patients are more likely to start on glatiramer acetate when tolerability, long-term safety, ease of therapy initiation, low cost to patient, and/or payer coverage are the main factors considered for choosing a treatment.

Spherix’s data suggests that Genentech’s past dominance in PPMS “may be under threat” due to pressure for trying a generic glatiramer acetate first. Also, neurologists anticipate switching 75% of so-treated PPMS patients to Copaxone if they respond poorly to generic glatiramer acetate, which would further minimize Ocrevus’ use as a second-line option.

This changing landscape “may strengthen the commercial opportunity for late-stage pipeline agents in development for PPMS,” Spherix said, citing MedDay Pharmaceuticals‘ Qizenday (MD-1003), AB Science‘s masitinib, two oral candidates for progressive forms of MS, and Mapi Pharma and Mylan’s GA Depot, a once-a-month injectable formulation of glatiramer acetate in development for relapsing MS and PPMS.

In fact, patients identified as likely candidates for starting treatment with Qizenday or masitinib (had they been already approved) are more likely to be newly diagnosed PPMS patients. Conversely, MS type does not seem to affect the first-line choice of GA Depot in the future.