Comparable effectiveness and persistence of ocrelizumab, natalizumab

A retrospective analysis compared 2 widely used and highly effective MS treatments: ocrelizumab and natalizumab. Over a period of 5 years, effectiveness and treatment persistence were comparable. On the other hand, ocrelizumab was associated with a higher incidence of mild to moderate adverse events (AEs).

Ocrelizumab and natalizumab are both high-efficacy monoclonal antibodies widely used in clinical practice. Dr Elena Barbuti (Sapienza University of Rome, Italy) set up a study which analysed data from patients with MS who started either therapy between 2010 and 2019, followed up in the university hospitals of Rome or Napoli, and had either relapsing or progressive MS.

The study population consisted of 308 patients, including 140 who used ocrelizumab and 168 who used natalizumab. In this original cohort, patients in the ocrelizumab group were older (mean age 49.9 vs 42 years; P<0.001), less often active (42.1% vs 87.5%; P<0.001), and less frequently treatment-naïve (22.9% vs 33.9%; P=0.03). Propensity score matching resulted in a cohort of 140 patients, comprising 70 pairs of patients, with one patient in each pair treated with ocrelizumab and the other with natalizumab. The mean follow-up in this cohort was 55.9 months. Dr Barbuti said that no significant differences were found between natalizumab and ocrelizumab in the following outcomes:

• No Evidence of Disease Activity 3 (NEDA-3): HR 0.64 (95% CI 0.34–1.24; P=0.19).
• Number of relapses: HR 0.41 (95% CI 0.11–1.57; P=0.19).
• MRI activity: HR 0.37 (95% CI 0.10–1.44; P=0.15).
• Expanded Disability Status Scale (EDSS) progression: HR 1.43 (95% CI 0.60–3.40; P=0.42).

Of note, ocrelizumab was associated with a higher risk of adverse events (AEs): OR 4.50 (95% CI 1.53–16.50; P=0.01). Of the 140 patients, 19 developed one or more AEs; 15 of these patients were on ocrelizumab. However, most AEs were blood test abnormalities, and none were life-threatening. Treatment discontinuation rates were comparable for both drugs.

1. Barbuti E, et al. Ocrelizumab versus natalizumab in multiple sclerosis: a propensity-score study. OPR-037, EAN Congress 2025, 21-24 June 2025, Helsinki, Finland.

Medical writing support was provided by Michiel Tent.

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Posted on 24 June 20253 September 2025