Early Uptake Analysis of Ocrelizumab Highlights Shifting and Distinct Treatment Paradigms By Multiple Sclerosis Subtypes

Background: Quarterly survey fielded by an independent market intelligence agency which specializes in tracking the US disease-modifying therapy (DMT) market, including benchmarking new launch metrics, in multiple sclerosis (MS).

Objectives: Characterize impact of ocrelizumab, approved for relapsing forms of MS (RMS) and first-to-market for primary progressive multiple sclerosis (PPMS), on the MS market in the United States.

Methods: Fielded in November 2017, 103 US neurologists provided responses to an online survey. Trending will be provided from surveys fielded quarterly since June 2017.

Results: 75% of collaborating US neurologists report use of ocrelizumab within the first seven months of availability, representing 974 ocrelizumab-treated patients. Ocrelizumab-treated patients are primarily diagnosed with relapsing remitting MS (RRMS) or active secondary progressive MS (aSPMS), with the aSPMS share having increased significantly between August and November 2017. The majority of RRMS and aSPMS patients were previously treated with other DMTs, most frequently dimethyl fumarate, natalizumab, and the interferons. Among PPMS patients, 41% were initiated on ocrelizumab as their first DMT consistent with the higher percentage of neurologists who report being comfortable using ocrelizumab in treatment-naïve PPMS compared to treatment-naïve RRMS patients. Collaborating neurologists estimate that 28% of their RRMS patients, up significantly from 19% in August, and 52% of their PPMS patients are appropriate candidates for ocrelizumab. Half of neurologists believe that ocrelizumab would be appropriate for PPMS patients with no evidence of acute or chronic inflammation. Additional trending of ocrelizumab launch metrics and prescriber characteristics will be available at presentation.

Conclusions: Ocrelizumab is likely to expand the DMT-treated PPMS patient pool due to neurologists’ willingness to use ocrelizumab first line in PPMS as well as their belief that efficacy will not be limited to only patients with evidence of inflammation. In RRMS, where ocrelizumab uptake has been largely restricted to switching, the overall DMT treatment rate will likely remain stable. However, a shift towards high efficacy DMTs earlier in the RRMS treatment paradigm is anticipated.