Effectiveness of Ocrelizumab in Primary Progressive Multiple Sclerosis: a Multicenter, Retrospective, Real-world Study (OPPORTUNITY).

Abstract

Ocrelizumab is a recombinant humanized monoclonal antibody selectively targeting CD20-expressing B cells. The effect of ocrelizumab on primary progressive multiple sclerosis (PPMS) has been evaluated during phase 3 trials that enrolled patients under 55 years with a maximum Expanded Disability Status Scale (EDSS) of 6.5. However, little is known on older disabled patients with longer disease duration. We aimed to assess the clinical effectiveness of ocrelizumab in PPMS patients out of the ORATORIO eligibility criteria. This multicenter retrospective study collected data about the effectiveness of ocrelizumab in PPMS patients who received treatment between May 2017 and June 2022 in the Italian MS centers contributing to the Italian MS Registry who adhered to the Compassionate Use Program. The confirmed EDSS worsening (CEW) (defined as either a ≥ 1-point or ≥ 2-point increase in EDSS score from baseline that was confirmed at T12 and T24) was calculated. At the date of data extraction, out of 887 PPMS patients who had received ocrelizumab, 589 (mean age 49.7 ± 10.7 years, 242 (41.1%) females) were enrolled. The mean follow-up period was 41.3 ± 12.3 months. A total of 149 (25.3%) received ocrelizumab according to the ORATORIO criteria (ORATORIO group) and 440 (74.7%) outside the ORATORIO criteria (non-ORATORIO group). No differences in terms of cumulative probabilities of 12 and 24 months of CEW of ≤ 1 point were found between ORATORIO and non-ORATORIO groups. Cox regression analyses showed that age older than 65 years (HR 2.51, 25% CI 1.07-3.65; p = 0.01) was associated with higher risk of CEW at 24 months. Patients not responding to ORATORIO criteria for reimbursability may benefit from ocrelizumab treatment, as disease activity, disease duration, and EDSS seem to not impact the disability outcome. Our results may suggest to extend the possible use of this powerful agent in selected patients under the age of 65 years.

• Authors: Clara G Chisari, Assunta Bianco, Vincenzo Brescia Morra, Massimiliano Calabrese, Fioravante Capone, Paola Cavalla, Carlotta Chiavazza, Cristoforo Comi, Maura Danni, Massimo Filippi, Pietro Iaffaldano, Roberta Lanzillo, Salvatore Lo Fermo, Alessandra Lucisano, Alessandra Lugaresi, Giacomo Lus, Gerolama Alessandra Marfia, Fabiana Marinelli, Massimiliano Mirabella, Lucia Moiola, Chiara Perin, Sabrina Realmuto, Simona Toscano, Maria Trojano, Domizia Vecchio, Francesco Patti, Italian MS Registry
• Journal: Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics (Neurotherapeutics) Vol. 20 Issue 6 Pg. 1696-1706 (Oct 2023) ISSN: 1878-7479 [Electronic] United States
• PMID: 37610702 (Publication Type: Multicenter Study, Journal Article)
• Copyright: © 2023. The Author(s).

Chemical References

• ocrelizumab
• Antibodies, Monoclonal, Humanized
• Immunologic Factors

Topics

• Female
• Humans
• Adult
• Middle Aged
• Aged
• Male
• Multiple Sclerosis (drug therapy)
• Multiple Sclerosis, Chronic Progressive (drug therapy)
• Retrospective Studies
• Antibodies, Monoclonal, Humanized (therapeutic use, pharmacology)
• Multiple Sclerosis, Relapsing-Remitting (drug therapy)
• Immunologic Factors (therapeutic use, pharmacology)