Treatment Patterns and Therapy Selection Drivers Comparison between Anti-CD20 Agents Among Multiple Sclerosis Patients Who Recently Switched Disease-Modifying Therapies

Background: With the recent approval of ofatumumab (OFA), physicians and patients have additional options when selecting an anti-CD20 disease-modifying therapy (DMT) for the treatment of multiple sclerosis (MS).

Objectives: To compare switch treatment patterns and therapy selection decisions between DMTs with anti-CD20 mechanism of action (MOA).

Methods: 233 US neurologists completed a survey and provided cross-sectional chart data from January 28th to March 1st, 2021, on MS patients who switched to a new DMT within the prior 3 months. Analyses focused on switches to ocrelizumab (OCR; n=144), OFA (n=47), and branded or biosimilar rituximab (RTX; n=41).

Results: The majority of switches to OCR (65%) and RTX (63%) were from first-line DMTs; switches to OFA were commonly from first- or second-line DMTs (43% and 49%, respectively).

Patients switching to RTX frequently came from a generic DMT (29%) or interferon (29%). Half of switches to OCR were from an oral DMT, most often dimethyl fumarate (23%) or fingolimod (15%). Switches to OFA were often from other monoclonal antibodies (36%), most frequently OCR (21%).

For each of the anti-CD20 DMTs, the desire for a high efficacy agent (OCR: 57%; OFA: 51%: RTX: 56%) and the MOA (OCR: 54%; OFA: 53%: RTX: 44%) were influential reasons for switching to the brands.

For OCR, its unique primary progressive MS indication also played an influential role in DMT selection (23%). Administration type preference (40%), perception that patient is highly adherent with medical instructions (36%), COVID-19 pandemic-appropriate option (9%), and starter kit availability (7%) were more influential reasons for selecting OFA. RTX selections were more likely to be influenced by physicians’ comfort/familiarity (36%), no/low monitoring requirement burden (21%), payer preference (21%), and low patient cost (26%).

If the current DMT had not been available at the time of prescribing, common alternative options included other anti-CD20 options (OCR: 41%; OFA: 42%: RTX: 33%). Among current OFA-treated patients, the subcutaneous DMT was selected instead of infused OCR due to better convenience (67%) and preferred administration method (44%). RTX was selected over OCR because of expectations of lower patient copay (62%) and less managed care hassles (46%).

Conclusions: Treatment history and DMT selection drivers varied between MS patients recently switched to different anti-CD20 agents. OFA is more likely to be used later line compared to OCR and among patients where the once-monthly subcutaneous dosing profile was influential in the switch decision. RTX, used off label for the treatment of MS, was used in place of OCR when market access was a concern.