AAN 2019: Update on MS meds
The American Academy of Neurology (AAN) annual meeting is the year’s largest gathering of neurology researchers. Here is a sampling of new studies of disease-modifying therapies used to treat multiple sclerosis.
Mayzent: This drug has just been approved in the U.S. for the full range of relapsing MS, including relapsing-remitting and secondary-progressive MS. An analysis of the pivotal trial that led to drug approval looked at the effects of Mayzent on cognition (Benedict and colleagues. AAN 2019; abstract P3.2.051). Mayzent was better than a placebo both in improving cognitive test scores and in slowing impairment, so it may be effective both for the mental and physical impairments associated with MS.
Ocrevus: People enrolled in the original trials of Ocrevus have now been treated for 5 years. According to the latest results, ocrelizumab slows the development of disability, although the proportion of people with worsening MS does gradually increase, from 6.5% in Year 3 to 10.4% in Year 5 (according to a new method they are now using to measure disability) (Hauser and colleagues. AAN 2019; abstract P3.2.054). Similar results were seen in people with primary-progressive MS (PPMS) (Wolinsky and colleagues. AAN 2019; abstract P3.2.031). After three years, about 1 in 3 people with PPMS had worsening disability and about 44% after 5 years. A safety analysis of 3800 people taking Ocrevus found that infections were a frequent side effect, although serious infections were uncommon (Hauser and colleagues. AAN 2019; abstract P4.2.025). Also of interest: a U.S. survey reported that doctors prescribed Ocrevus for PPMS in about one-half of their cases (Naismith and colleagues. AAN 2019; abstract P1.2.102). The other half received another drug despite the fact that these other medications have not been shown to be effective for PPMS. Men were significantly more likely to be prescribed Ocrevus than women.
Mavenclad: This oral drug is one of the newer MS medications to become available and was recently approved in the U.S. for relapsing-remitting and secondary-progressive MS. It’s an oral drug taken 8-10 days a year for two years. The most recent safety analysis reported that the infection rate is similar to what’s seen with a placebo, although there is an increased risk of shingles (Cook and colleagues. AAN 2019; abstract P4.2.046). Most people were relapse-free in any given year.
Gilenya: A 5-year analysis of over 800 people found that Gilenya continues to be effective over the longer term, with 90% of people having stable or improved disability scores (Ziemssen and colleagues. AAN 2019; abstract P3.2.086).
Tecfidera: A subgroup of people in the two clinical trials of Tecfidera were newly-diagnosed. After nine years on treatment, relapses were uncommon and most people (93%) had little or no walking impairment (Gold and colleagues. AAN 2019; abstract P3.2.084). However, most people had stopped taking Tecfidera by the end of the 9-year period. A separate safety analysis for people taking Tecfidera for up to 11 years reported that although Tecfidera has effects on the immune response, these generally weren’t associated with a higher risk of developing infections (Chan and colleagues. AAN 2019; abstract P4.2.023).
Tysabri: This is one of the most potent MS drugs available but its use is often limited to two years because of concerns about the cumulative risk of PML (progressive multifocal leukoencephalopathy), a potentially fatal brain infection. The cumulative PML risk during 6 years of treatment has been estimated to be 1.7-2.7% (Ho and colleagues. Lancet Neurol 2017;16:925-933). A number of recent studies have looked at the impact of less frequent dosing on PML risk (a dose every 6-12 weeks instead of the standard dosing of every 4 weeks). The latest analysis found that there was a significantly lower risk of developing PML if the drug is taken less frequently (Zhovtis Ryerson and colleagues. AAN 2019; abstract S26.006), although rare cases of PML have been reported (Scarpazza and colleagues. ECTRIMS 2018; abstract P1247). The potential safety advantages of less frequent dosing are now being explored in the NOVA phase III trial.
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