Real-world figures on the efficacy of anti-CD20 in PPMS

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In the UK ocrelizumab, an anti-CD20, is licensed for the treatment of Primary Progressive MS (PPMS) and Relapsing Remitting MS (RRMS). Rituximab, although not licensed for use in MS in the UK is also an anti-CD20 therapy with immunosuppressive properties. The two are matched in their efficacy in terms of reduction in disease progression (see Figure below) and serum neurofilament (sNfL) in PPMS.

figure 2
Figure: Survival curve showing time to confirmed disability progression for each group. Rituximab group is shown with a continuous line, ocrelizumab group is shown with a dashed line. Rituximab-censored and ocrelizumab-censored cases are represented with circles and vertical lines, respectively. No differences in time to confirmed disability progression were encountered (p = 0.356, logrank test)

Treatment options for PPMS is scarce with ocrelizumab being the main option in most countries, with efficacy data outside of clinical trials being scarce. In such instances, it is useful to look at independent real-world data.

Real world data (RWD) in medicine is data derived from a number of sources that are associated with outcomes in a heterogeneous patient population in real-world settings, including but not limited to electronic health recordshealth insurance claims and patient surveys. While no universal definition of real world data exists, researchers typically understand RWD as distinct from data sourced from randomized clinical trials. [source: Wikipedia]

In the latest RWD from France, their two-year follow up data shows that roughly more than a third of individuals with PPMS on anti-CD20s experienced disease progression as measured by EDSS. This figure when faced with the risk calculations of anti-CD20s seems somewhat small, but given that those starting were at an EDSS score of 6 (using a walking stick) with numerous MRI head lesions and long disease duration and should be factored into this. However, this figure is useful to know when considering therapeutic options in PPMS and setting the bar for others in the future.

Abstract

J Neurol. 2022 Apr 17. doi: 10.1007/s00415-022-11124-9. Online ahead of print.

Anti-CD20 immunotherapy in progressive multiple sclerosis: 2-year real-world follow-up of 108 patients

Maximilian Einsiedler Laurent Kremer Marie Fleury Nicolas Collongues Jérôme De Sèze Kévin Bigaut 

Background: Anti-CD20 monoclonal antibodies are recently introduced treatments in progressive MS and real-world data are lacking.

Objective: The aim of this study is to describe a cohort of progressive MS patients treated with ocrelizumab or rituximab in a real-world setting.

Methods: This monocentric prospective cohort study at the University Hospital of Strasbourg included patients with primary progressive or secondary progressive MS that started treatment with anti-CD20 antibodies before June 2019. Every six months, patients were assessed using the following standardized clinical evaluations: Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9-HPT) and Symbol Digit Modalities Test (SDMT). The primary analysis considered EDSS progression (of at least 1.0 if EDSS ≤ 5.5 and at least 0.5 if EDSS ≥ 6.0).

Results: We included 108 patients, with a median age upon inclusion of 53 years [48.0-58.0]. 72% were classified as primary progressive forms. Median baseline EDSS was 6.0 [4.0-6.5]. EDSS was significantly correlated with T25FW, SDMT and 9-HPT. Following 2 years of treatment, 38.9% of patients presented EDSS progression compared to baseline.

Conclusion: Our large cohort confirms tolerance of these treatments in a real-world setting. Standardized clinical assessments could improve detection of deteriorating patients. Further studies are needed to establish predictive factors.

About the author

Neuro Doc Gnanapavan

9 comments

  • Rituximab-censored and ocrelizumab-censored cases are represented with circles and vertical lines, respectively. No differences in time to confirmed disability progression were encountered (p = 0.356, logrank test)

    So basicaly

    The saying goes

    Rituximab is 10% less efficacious
    10% with more side efects
    and 10 times cheaper

    (some critic i seen manny moos ago)

    Nice work

  • > This figure when faced with the risk calculations of anti-CD20s seems somewhat small,
    lol… Only MS specialists could think that any reduction in brain damage is “small” and worth discussing whether patients should be denied treatment on the basis of “risk calculations.” Every neurologist who ever denied someone a DMT because of “side effects” deserves to get MS.

    • I think that statement is said on whim (from your end) and you should never wish an illness on anyone.
      My point in making the statement if you were unable to read between the lines is that we need to do significantly better than this.

  • Dear NDG,

    So much MS research is smoke and mirrors. So many numbers, percentages etc. What the PPMS patient wants to know is simple ie does it work (by work I mean slow down the accumulation of disability)? My friend with advanced breast cancer was told by her oncologist that 80 percent of her patients with the same disease taking drug X were still alive 5 years later. This information helped my friend decide. From the various Anti-CD20 drug research I have read, the impact on slowing the accumulation of disability seems minimal. Would you take it if you had PPMS?

    • So one way of looking at this result is that over a two year period it works in roughly thirty percent of individuals. Beyond this the figure of the number of people it works on will steadily decrease.

      • I actually find this way to interpret efficacy less helpful and confusing. If anti-CD20 doesnt eliminate damage, the survival rate is really always 0%, it is only a matter if it can be picked up on tests or MRI’s.

        Quantified data on average protection (year 1 it reduces damage by 70%, year 2 80%, year 3 90%) would be much easier to understand. Yes if you put these numbers together survival figure keeps going down.

  • Could you explain the findings in simple language?
    How different are ocrelizumab and rituximab in controlling progression, esp in people with PPMS

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