Ocrelizumab Safety Profile in Elders, Phase 3b CASTING Trial Results, Cannabis Information Sources for MS

Neurology News Network for the week ending October 30, 2021.

WATCH TIME: 3 minutes

This week Neurology News Network covered a trio of presentations from the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers, including findings on adverse events in older patients on ocrelizumab, the effects of switching to ocrelizumab on work productivity, and where patients with MS get their information on cannabis.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus. This week’s episode is centered around the recently concluded CMSC Annual Meeting.

For patients with multiple sclerosis (MS) who have higher baseline levels of disability and those who are older, treatment with ocrelizumab (Ocrevus; Genentech) does not appear to be associated with a higher rate of adverse events (AEs), according to the real-world results of ACAPELLA, a single-center, prospective study. Presented in a poster at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), October 25-28, the data show that those with an Expanded Disability Status Scale (EDSS) score of 6 or higher had a slightly higher rate of urinary tract infections, but no increased incidence of infections (45%; n = 37) or Herpes simplex virus (HSV) 1 or 2 compared with the overall population of 354 patients. Similar results were observed for the group aged 55 years and older for rates of both HSV-1 and 2 (7%; n = 28) and overall moderate infections (37%; n = 49).

Switching to ocrelizumab from other disease-modifying treatments (DMTs) for multiple sclerosis is associated with improvements in work productivity and a decrease in overall symptom burden, according to an analysis from the phase 3b CASTING trial. In this analysis, 680 patients with MS with a suboptimal response to 1 or 2 prior DMTs received 600 mg intravenous ocrelizumab every 24 weeks for 96 weeks, during which changes in the Work Productivity and Activity Impairment (WPAI) questionnaire, 29-item Multiple Sclerosis Impact Scale (MSIS-29), and SymptoMScreen (self-reported symptom burden) were assessed at baseline, week 24, year 1, and year 2. From baseline to year 3, significant reductions in overall work impairment and activity impairment were recorded as improvements in WPAI (∆−3.08, = .020; ∆−5.69, < .001), with consistent trends noted in work time missed (∆−2.54, P = .102) and impairment while working

Although most patients with multiple sclerosis (MS) had discussed cannabis with their MS physician, only 12% of patients considered them their primary source for medical guidance on the matter, suggesting that inadequate medical and clinical information sources are available to these patients and their healthcare providers. There are currently no tetrahydrocannabidiol-containing FDA-approved medications for physicians to prescribe patients with MS. In total, 48% of ever users reported that either nobody or themselves was the primary person providing medical guidance for cannabis use. Dispensary professionals, used by 21% of the entire cohort, were the second most, ahead of MS physician (12%), other physicians (8%), other patients with MS (8%), other licensed healthcare providers (3%), and pharmacists (1%).

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