Hi all
I went to sign my consent form for Ocrevus infusion yesterday but was told by MS consultant that the efficacy is only 46%? This is different to what I was told by the lovely MS nurses (they said 70-76%). Ultimately, the consultants statistic led me to have a blood test and consider Tysabri instead when previously I’d been set on Ocrevus (better for work life, little risk of PML in comparison). Does anyone know the correct efficacy of Ocrevus vs placebo please?
Hi,
That’s really disconcerting!
The statistic I’ve seen quoted for ocrevus is that it reduces relapses by 46% and slows disability worsening by 40% compared to beta interferons (NOT compared to placebo).
Beta interferons in turn seem to reduce relapses by about 30% compared to placebo.
I think the clinical trials were called OPERA I and OPERA II - you could try googling them and see if you can find the trial report.
Why are they comparing to beta interferons and not to a placebo?
Well, because by the time the trials were taking place, beta interferons were already available. So they could not say to RRMS patients, “Hey, would you like to take part in a clinical trial, with 50% chance that you will be in a control group taking a placebo (i.e. no DMT…)”. It wouldn’t be ethical to ask someone with RRMS to do that. They compare new drugs with the existing established treatment. They did test ocreluzimab versus placebo for progressive MS, I think, but that’s not relevant to you.
That does make it harder for us to compare, as some other drugs were tested against a placebo.
Tysabri seems to have reduced relapses by 68% compared to placebo - from info on the MS Society website.
If you google “MS selfie info cards” there are some useful cards on DMTs that you can use to compare efficacy. They have been produced by a researcher at Barts, I think (you can check).
My impression is that basically the anti-CD20 drugs (ocrevus etc) and tysabri are all relatively high efficacy as things go… minor differences may not be so relevant given the individual variation in MS/drug response anyway, so then it’s reasonable consider side effects (eg PML) and convenience. Once you are started, you may need to switch anyway if a particular drug does not work for you, for whatever reason.
The main thing is probably to get started on something… delay is not so great for MS.
I agree. Getting on a high-efficacy DMD - any high-efficacy DMD - is probably the priority here. As I understand it, if you’re choosing purely on efficacy, Tysabri wins, but there are other considerations too, as greenjo notes.
TBH I suspect there is more than a little finger-in-air-ism about how these efficacy % are calculated and compared. In any case, trial results don’t have a fat lot to say about how any one individual is likely to get on in the real world, which is the only thing that matters in the end.
You need reasonable info to make an informed choice, of course, and it’s unsettling to think you have solid information and then have cause to question how accurate it is, and I would share greenjo’s perplexity here, for sure. But in truth even the best and most accurate information isn’t going to give us the full picture, because the information does not exist yet. There’s a natural experiment going on with all these drugs, and we’re it!