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Ocrelizumab

Overview
How does it work?
How is it given?
What are the results so far?
Side effects
What further studies are planned?
References

Overview

Drug in development
Ocrelizumab RRMS
Ocrelizumab PPMS
Other names RG1594
What is it for? Relapsing remitting and primary progressive multiple sclerosis (MS)
  • Ocrelizumab is an experimental drug treatment for relapsing remitting and primary progressive MS. It is given as an intravenous infusion every 6 months.
  • Ocrelizumab targets a marker (CD20) on the surface of B cells, which are thought to influence the abnormal immune response that causes the immune system to attack the myelin surrounding nerve.
  • Preliminary results indicate that for relapsing remitting MS ocrelizumab is twice as efffective as current disease modifying treatments.
  • In clinical trials, serious side effects were rare and comparable in all treatment groups.
    • One patient talking ocrelizumab died due to brain oedema (swelling), after the occurrence of systemic inflammatory response syndrome with multi-organ failure.

How does it work?

Ocrelizumab is a monoclonal antibody, a type of drug developed to attack specific targets in the immune system. Ocrelizumab has been designed to target a marker (CD20) on the surface of B cells, which are thought to influence the abnormal immune response that causes the immune system to attack the myelin surrounding nerve. The drug is a humanized version of rituximab, a mouse antibody to CD20 that has shown benefit in people with relapsing remitting MS.

Ocrelizumab has previously been investigated as a treatment for rheumatoid arthritis but studies were discontinued because of a high incidence of opportunistic infections in participants. Opportunistic infections are infections that do not normally occur in a healthy person but may occur when the immune system is compromised.


How is it given?

Ocrelizumab is given as an intravenous infusion on days 1 and 15 at approximately six month intervals.


What are the results so far?

    Relapsing remitting MS

  • In a phase II, 24 week, clinical trial, 218 people were split into groups receiving one of two doses of ocrelizumab (600mg and 2000mg), interferon beta-1a (Avonex) or placebo. After 24 weeks, the number of active lesions as measured by MRI scans was 89% lower in the low dose group and 96% lower in the high dose group compared with the placebo group.

    At 24 weeks the annual relapse rate was 0.13 in the low dose group and 0.17 in the high dose group compared to 0.36 for people on interferon beta and 0.64 in the placebo group.

    In an extension to the study, participants were all switched to ocrelizumab treatment and reduction in relapses was maintained. Results from up to week 96 were reported at ECTRIMS 2011.


Side effects

In the phase II RRMS study, serious side effects were rare and comparable in all four groups. However, one patient in the ocrelizumab 2000mg group died due to brain oedema (swelling), after the occurrence of systemic inflammatory response syndrome with multi-organ failure. The connection of this death to ocrelizumab is unclear.

At first infusion, more people in the ocrelizumab groups (35%, 44%) had infusion-related adverse events than did those in the placebo group (9%).


What further studies are planned?

  • Relapsing remitting MS: Opera I and II

    These phase III studies are each recruiting 800 participants with relapsing remitting MS who will take either ocrelizumab 600mg every 24 weeks or interferon beta 1a (Rebif) for 96 weeks.

    The main measure of these two trials is the effect of treatment on relapse rate.

    Recruiting began in August 2011 and the trials are due to finish in 2015.
    Further details of Opera I study.

    Further details of Opera II study.

  • Primary progressive MS: Oratorio

    This phase III study will recruit 630 participants with primary progressive MS. Treatment will be either 600mg ocrelizumab by iv infusion every 24 weeks or placebo, initially for 120 weeks (approximately 2 years). At the end of this period, participants who would be considered to benefit from continuing or switching to ocrelizumab treatment will be able to carry on with treatment for up to 5.5 years.

    The main measure of the study will be the time taken to onset of sustained disability progression, defined as an increase in Expanded Disability Status Scale (EDSS) score that is sustained for at least 12 weeks.

    Recruiting began in March 2011 and the trial is due to finish in 2017.
    Further details of Oratorio study.


References

Kappos L, et al.
Ocrelizumab in relapsing-remitting multiple sclerosis: a phase 2, randomised, placebo-controlled, multicentre trial.
Lancet 2011;378(9805):1779-87
Read abstract