Multiple sclerosis (MS) is an autoimmune condition that affects the central nervous system (i.e. the brain and spinal cord). A significant number of people are affected by MS, with in excess of 150,000 people diagnosed with the condition in the United Kingdom alone. This disease can cause tiredness, issues with vision and limb movement plus reduced nerve sensation and poor stability whilst walking or standing. This chronic condition arises because the immune system attacks the myelin sheath on the outside of nerve fibres, by doing so the speed of nerve transmission is reduced, hence leading to the issues described. MS can be mild or it can cause severe disability over time.
There has recently been a breakthrough in the management of MS with the development and release of the new product called Ocrevus® (i.e. marketing authorisation was granted on 09 July 2024 to Roche), and we thought to release a Blog post on this at www.pharmascholar.co.uk to help raise awareness and educate others. This preparation contains the drug called Ocrelizumab, which is a monoclonal antibody. Ocrelizumab targets CD20-positive B cells (i.e. a type of white blood cell) in a selective manner. This is important because these cells play a crucial role in the immune response. As a result of binding to this cell type, the monoclonal antibody is able to reduce B cell numbers and hence reduce inflammation and the damage to the myelin sheath. Thus, Ocrelizumab is able to slow disease progression and thereby alleviates MS symptoms. The product is useful in two types of patients; namely, those with relapsing remitting MS (RMS) where the individual has exacerbations followed by periods with mild / no symptoms or those with primary progressive MS (PPMS), where symptoms get worse with time.
This monoclonal antibody has previously been applied in the clinical setting in the United Kingdom. During 2018, Ocrelizumab was approved for use as an intravenous infusion with the first two infusions being given two weeks apart and subsequent infusions every six months. Naturally, this is inconvenient for the patient and is also an added expense for the National Health Service. The clear advantage with the Ocrevus® product is the delivery of the monoclonal antibody at a 920mg dose via the subcutaneous route every 6 months; the formulation can be delivered by a trained healthcare professional such as a Nurse or Doctor. Potentially, after a period of suitable training the patient can deliver the formulation themselves (i.e. a positive move away from the hospital-based intravenous system).
This product has shown great potential in the clinical space. For example, those patients diagnosed with RMS have noted a reduction in the frequency of relapses, a slowing of the disease and reduced brain lesions. For those diagnosed with PPMS, then there has been a general slowing of disease progression alongside a reduced deterioration in walking speed.
As anticipated, common side effects from this product include adverse injection site reactions and an increased chance of acquiring infections (e.g. ‘flu, sinus infections, bronchitis and herpes infection).
For those interested, further information can be located at the following points:
2. NHS
To conclude, Ocrelizumab represents a significant development for MS management. This product will offer hope to patients with both the relapsing and progressive forms of the disease. The targeted approach employed, encouraging efficacy and ease of use make the product a valuable addition to the MS treatment landscape.
Ocrevus is now available as a subcutaneous formulation to manage MS.