In a cohort study, ocrelizumab proved to be superior to other disease-modifying treatments (DMTs) in achieving no evidence of disease activity (NEDA-3), as well as in reducing relapse risk and Expanded Disability Status Scale (EDSS) worsening. MRI results were less contrasting, possibly due to the limited sample size which was analysed.
A cohort study (1997–2021) aimed to evaluate the real-world effectiveness of different DMTs using relapses, EDSS, and MRI activity . Included were 1,986 relapsing MS patients with an average age of 39 years, 71.2% were women, and time since diagnosis was 8.4 years. Used as DMTs were dimethyl fumarate (n=670), glatiramer acetate (n=547), fingolimod (n=336), ocrelizumab (n=256), or natalizumab (n=177). The mean follow-up was 5.81±5.85 years.
Compared with ocrelizumab (which was used as a reference), the probability of relapse after 1 year was higher with glatiramer acetate (OR=27.27), dimethyl fumarate (OR 10.60), fingolimod (OR 16.28), and natalizumab (OR 17.20). After 2 years, probability of relapse was higher with glatiramer acetate and fingolimod versus ocrelizumab; there were no differences with dimethyl fumarate and natalizumab (see Figure). Again compared with ocrelizumab, EDSS was higher after 1 year with dimethyl fumarate, fingolimod, glatiramer acetate, and natalizumab. The same was true after 2 years (see Figure).
Figure: Relative probability of relapse and MRI lesions at year 1 and 2 
The probability of new/Gd-enhancing lesions was higher with glatiramer acetate (OR 4.02; 95% CI 1.74–9.27; P<0.01) compared with ocrelizumab. No differences were found for dimethyl fumarate (P=0.42), fingolimod (P=0.87), and natalizumab (P=0.11). The probability to achieve NEDA-3 status was lower in all groups compared with ocrelizumab. NEDA-3 was achieved by 90.23% of participants in the ocrelizumab group. For glatiramer acetate this percentage was 44.24% (HR 12.52; 95% CI 9.55–16.42; P<0.01), for dimethyl fumarate 62.08% (HR 1.66; 95% CI 1.30–2.11; P<0.01), for fingolimod 54.16% (HR 2.98; 95% CI 2.35–3.77; P<0.01), and for natalizumab 57.72% (HR 1.71; 95% CI 1.32–2.21; P<0.01). Ocrelizumab was superior to natalizumab in propensity score-adjusted analyses, which does not necessarily translate into differences at the level of the individual MS patients with high disease activity.
In summary, ocrelizumab was superior to other DMTs in achieving NEDA-3 and EDSS worsening. The less striking MRI results require ongoing analysis in a larger patient group.
- Moccia M. Comparing clinical and radiological effectiveness of disease modifying treatments in the real-world. Abstract O018, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.
Copyright ©2022 Medicom Medical Publishers
« Study fails to show non-inferiority of rituximab to ocrelizumab Next Article
How and when to make a timely switch to high-efficacy DMT »
Table of Contents: ECTRIMS 2022
Letter from the Editor
ECTRIMS 2022 Highlights Podcast
Diagnosis and Prediction of Disease Course
A case for including optic nerve lesions in the McDonald criteria
Cerebrospinal fluid kappa-free light chains for MS diagnosis
Early, non-disabling relapses increase disability accumulation
Physical impairment is present before perceived MS onset
Chronic active MS lesions respond poorly to anti-CD20 antibodies
Treatment: Trials & Strategies
Dimethyl fumarate reduces the risk of a first clinical event in RIS
How and when to make a timely switch to high-efficacy DMT
Comparing real-world effectiveness of DMTs
Study fails to show non-inferiority of rituximab to ocrelizumab
Autologous haematopoietic stem cell transplantation versus DMTs
Stem cell transplantation not superior to natalizumab in progressive MS
Efficacy of DMTs fades away in secondary progressive MS
Smartphone tapping can help detect progressive MS
Early treatment with DMT effective in paediatric-onset MS
Fingolimod in paediatric MS: results of up to 6 years
Switching treatment after initial platform injectable DMT: real-world data
Pregnancy and infant outcomes in women receiving ocrelizumab
New safety data of anti-CD20 mAbs around pregnancy
MS activity and pregnancy outcomes after long-term use of natalizumab
Ravulizumab significantly reduced relapses in AQP4+ NMOSD
NMOSD patients are cognitively impaired regardless of serostatus
Evidence-based consensus on pregnancy in NMOSD
COVID-19 and MS: lessons learned thus far
Ocrelizumab and fingolimod increase the risk of COVID-19 and of worse outcomes
Humoral and cellular immune responses after SARS-CoV-2 vaccination
Re-myelination strategies in MS still pose many unanswered questions
MS associated with a broader Epstein-Barr virus specific T-cell receptor repertoire
Cognitive rehab and mindfulness reduce cognitive complaints in MS
MRI-based clustering of MS patients
Evobrutinib reduces relapses and MRI lesion activity