MS Therapies: What’s Hot, What’s Not

MS Therapies: What’s Hot, What’s Not


Ocvevus (ocrelizumab) is off to a running start, Tecfidera (dimethyl fumarate) leads the pills and the four injectable multiple sclerosis drugs are being used by fewer MS patients. But Copaxone (glatiramer acetate injection) remains the leader of the pack of the disease-modifying therapies.

Those are some of the headlines from a recent report from Spherix Global Insights, a business intelligence and market research company that looks at drug trends every quarter. The sample size is small, with only about 100 neurologists answering an online survey, but it seems to do a good job of looking at the way disease-modifying drug use is trending.

The big three DMDs

The top disease-modifying drug, or DMD, continues to be Copaxone, a drug that’s injected either once a day or three times a week, depending on dosage strength. Copaxone has been around since 1996. Just more than 20 percent of the neurologists in the survey are prescribing it for patients. That’s followed by Tecfidera, a twice-daily pill (15 percent are prescribing) and Avonex (interferon beta-1a), another injection that was approved in the late 1990s (9.5 percent).

The trend, however, is toward change. Seventy-eight percent of the neurologists surveyed reported that during the past three months they had changed the drugs they were prescribing for some of their patients. The major changes were moving patients to Ocrevus (32 percent) or increasing the use of oral drugs, such as Aubagio (teriflunomide), 16 percent. Analysts at Spherix expect the use of Copaxone, Tecfidera and Avonex will fall by the time of their next quarterly report.


The big star of this report is Ocrevus.

Within a month of the drug’s launch, nearly half of the neurologists surveyed reported they had some of their MS patients using Ocrevus. Most of these patients were switched from another DMT, usually Tysabri (natalizumab) or Rituxan (rituxumab). But a sizable number were using no DMT before Ocrevus. That, according to the analysts, suggests some doctors had waited for Ocrevus to be approved by the U.S. Food and Drug Administration rather than starting a patient on a different drug and then switching.

Fifty-four percent of the patients for whom Ocrevus was prescribed had a diagnosis of relapsing MS, 31 percent were primary progressive, and 15 percent were secondary progressive. Analysts predict that, by their next report, Ocrevus use will jump from the current 1.5 percent to 5.8 percent of patients.

Here’s why:

Ocrevus vs. Tysabri

Ocrevus is seen as a big challenge to Tysabri. Both are infusions. The majority of the neurologists surveyed thought Ocrevus was more effective at halting MS progression than Tysabri. They also believed it carried less risk for the brain disease PML and that was more convenient for their patients. (Ocrevus is administered twice yearly, Tysabri is monthly).

On the other hand, Tysabri had the upper hand in terms of familiarity and comfort level for doctors and their staffs, and doctors said they saw fewer infusion reactions with it.

Ocrevus vs. Lemtrada

Only 3 percent of neurologists in the survey reported they had treated patients with Lemtrada (alemtuzumab) during the quarter. The neuros surveyed thought Ocrevus is more effective than Lemtrada for PPMS patients. (Ocrevus is the only FDA-approved DMD for progressive MS). On the other hand, the neuros gave a slight edge to the effectiveness of Lemtrada for RMS patients. Ocrevus was reported to be better tolerated by patients who had fewer infusion reactions. The comfort level of doctors and staff also was reported to be better with it.

What if you could choose only three?

When neurologists were asked which DMDs they would choose for their patients if they had only three from which to choose, the doctors were partial to “old reliables.” Copaxone, Tecfidera and Tysabri topped the list. Ocrevus came in fourth. But the doctors reported that 18 percent of patients are asking to be put on a specific drug, and they’re asking for Tecfidera, Gilenya (fingolimod), and Ocrevus.

The future

Forty-five percent of the neurologists surveyed report they’re using Ocrevus now. Seventy-nine percent said they planned to start using it. Aubagio, Lemtrada and Zinbryta (daclizumab) also are expected to see increased use.

Treatment goals and hurdles

There’s a lot more interesting information in the Spherix report, including what doctors say they want in a DMD, what goals they identify for patient treatment and what hurdles patients face getting insurers to pay for DMDs. I’ll take a look at these subjects in an upcoming column.

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  1. Liz says:

    Hi, just to comment I’ve been taking Tecfidera since Jan 2016…was diagnosed with MS in October 2015. For now…all is going well..just the rare hotflushes when I get stressed.

    • Ed Tobias says:

      Hi Liz,

      Thanks for your comment. I’m very glad to hear that all is going well for you with Tecfidera. Though there are some who disagree with me, I think that getting on a DMD quickly is one of the keys to limiting MS’ progress.


  2. Caroline Valls says:

    My brother is 57 and it took 3 years to diagnose MS he was diagnosed in November 2016. He started on Tecfidera at the beginning of June. So far no side effects but his problems with balance walking and speech are progressing at a fast rate. One asks if Ocrevus would be of any further help for him?

    • Ed Tobias says:

      Hi Caroline,

      I’m sorry that your brother’s MS is progressing quickly. The decision about which drug is best for him is one that needs to be made by your brother and his neurologist. The reports about Ocrevus indicate that it’s doing a good job of stopping progression, but it’s different for each patient.

      It’s my understanding that the National Health Service has not yet approved Ocrevus for use in the U.K. (I’m assuming, from your email address, that you and your brother are there) and it’s not expected to make a decision until sometime next year. But, now might be a very good time for your brother to research Ocrevus and discuss it with his doctor so that, if they decide to switch, they can be ready to roll if or when approval comes from the NHS.


  3. Jenny Bryan says:

    I’m really surprised that Lemtrada wasn’t one of the DMD go to’s. I have completed my first course and will begin my second course in a few weeks. I’ve had no relapses so far, which is excellent, considering I had breakthrough relapses on the other DMD’s since being diagnosed with RMS on October 31st of 2006. I do continue to have balance and cognition issues though from previous relapses. I don’t believe there is anything yet to fix these issues. Please correct me if I’m wrong. Thanks in advance for your input.

    • Ed Tobias says:

      Hi Jenny,

      I’m also being treated with Lemtrada (Round 1 was last December) and I’m doing well. Some Lemtrada patients are saying they’ve seen improvement in cognition and walking, and I assume that “walking” includes balance. Of course, that varies with each individual. I can tell you that, though I’ve really not had any real issues with cognition since I was DXed in 1980, I do feel a little sharper, mentally, since the Lemtrada treatment.

      As for why Lemtrada wasn’t seen as a go-to DMD, I think there are two reasons. First, there was a massive PR/marketing campaign surrounding the Ocrevus approval and I think that it succeeded in pushing that drug to front-of-mind for many neurologists, as well as for MS patients, in the second quarter of 2017. Secondly, Genetech, the company that makes Ocrevus, was successful in avoiding any “black box” side effect warning on the drug’s label, while Lemtrada wasn’t. So, rightly or wrongly, the perception may be that Ocrevus is a safer DMD than Lemtrada.


    • Ed Tobias says:

      Thanks for the comment, Kevin.

      The survey only looked at the drugs that were being used, or considered, as treatments. Other treatments, such as HSCT, weren’t included. It would, indeed, be interesting to ask neurologists about their views of HSCT and whether they think the FDA has been dragging its feet regarding its approval.


  4. Debbie Bright says:

    Ed, thanks for writing this article. Extremely interesting. I never would have guessed that Copaxone would be the most prescribed (of those surveyed). Interesting how we see through our own lens. It would be interesting to break the survey down further -urban/rural, for example.
    Thanks again, Debbie

    • Ed Tobias says:

      Hi Debbie,

      Yes, very interesting…though the survey sample is very small. There are lots of ways that this info could, potentially, be “sliced and diced” but the research company that creates the survey hasn’t gone that far.

      Thanks for your comment.


  5. herman wadmann says:

    it should be noted that Lemtrada does not need to be given indefinitely unlike all other MS drugs. A short course suffices for most pateints

    • Ed Tobias says:

      Hi Herman,

      That’s true. I know that well, since I’m being treated with Lemtrada. What I wrote was limited to what this survey of doctors reported. It wasn’t intended to list the pluses and minuses of various DMTs. But I appreciate that you took the time to point out that benefit.


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