News flash Ocrevus has been approved for Primary Progressive MS…………in UK


This is not news if you are in say the US and Australia, but when Scrooge is in charge of the purse strings, as they are in the UK, then there has to be some behind the Scenes negotiation on price.

Ocrelizumab is cost effective for relapsing MS but how do you rate ocrelizumab for primary progressive MS. Well NICE have driven that hard bargain and Roche has obliged and so the NHS has got the green light for approval of use for PPMS. Therefore now there is an option for every one with active disease. This is excellent news and when ProfG wakes up in the US he may have something to say.

The landscape will change and now we need agents that can go on top of such drugs. Siponimod has been knocking on SPMS’s door too and in US has already been approved for SPMS and so there the whole range of MS is covered with an anti-inflammatory DMT.

This is good but it is also perhaps bad news because it makes it harder to get new agents into that space. We are kidding ourselves if we think these types of agent are the complete answer. They are not because people continue to progress albeit at a slower rate on these drugs. So to get a new drug in you may have to do your new treatments against standard of care in your trials and this could add £30,000,000-£50,000,000 to the price as you would have to buy the comparator.

So interesting times ahead.

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  • Yes kind of good news but the criteria imposed by nice is very restrictive for those with primary progressive. I.e. be able to walk 20 m with or without an aid and show MRI activity.

    Another question you talk about the need for the other drugs to be layered on top but if your Ms is stable with no visible activity will the protective and remyelination drugs be offered and going one step further be offered to people in wheelchairs?

  • Stunning news MD – a game changer for PW PPMS in the UK like me.

    Will individuals who have previously had other DMT’s be eligible?

    Will this be limited to individuals with specific EDSS levels?

    Happy day for me – hope I can get on this soon.

  • Have had slow PPMS nearly 2 decades. Not at all excited, as I don’t believe I have active disease and don’t want the added cancer risk or other side effects for just possible slowing of worsening.

  • Can the drug be prescribed immediately by neurologists or will there now be a further wait for patients?

    • Usually, implementation period is 3 months, however since pathway for use in relapsing MS already exists, may be quicker.

  • These medications (ocrezulimab, cladribine and siponimod) are clearly not the answer in the majority of progressive MS cases.

    As the FDA wisely pointed out, they have NO EFFECT above placebo in “non-active” progressive MS which the majority of progressive patients are. Their only effect is on “active” progressive MS seen in their selection bias trials in which they will slightly delay your decline to the same miserable outcome and only noticeable to the statistician paid by Pharma, not the patient.

    One will not improve their clinical condition on any of these drugs. One will have to wait for remyelination, neuroprotective and neurorestoration products which should be available at your pharmacy in a few decades because of the corrupt stagnant state of MS research.

    When is this immunosuppressive-only madness with recycled drugs going to end in treatment of progressive MS? The only one who are improving are the bank accounts of Pharma with their shareholders and their “card carrying” neurologists.

  • I’d like to see Ocrevus vs Ocrevus + a tetracycline antibiotic combination over 12 months. I know the Bart’s team think viral (EBV) but i’m thinking bacterial. We know minocycline reduces relapse rates further when given in combination with Capaxone (vs Capaxone alone). My guess is that if the study was Capaxone vs minocycline they would have found the later superior (Teva weren’t that silly though).

    • You see the logic of combining a DMT with a neuroprotective it is amazing it is taking so long for neuros to see this.

      • Indeed. It’s amazing how many clinicians don’t put all the pieces together. I’ll be talking to my wife’s (new) neurologist about which combinations we can try. Luckily, he seems to be a thinker (the last one was a dope). Living in Australia also means we are not restricted to which DMT she can access. I’m new to MS (wife newly diagnosed) but I work in clinical research. So, having an understanding of how industry sponsored clinical research is conducted helps. For example, any time a pharma company runs a study against an already available drug (e.g Rebif) straight away tells you the comparator is the worst performing drug available. So, we ruled out Rebif (and all the CRABs) without even talking to the neurologist.



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