Those who have been with DocBlog for a while know: autumn is congress time. As always at this time, the world’s largest MS meeting took place again this year – almost 10,000 MS experts from all over the world participated in the congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in Barcelona last week. And they exchanged news about multiple sclerosis and related diseases.
As every year, I would like to pick out a few selected news from the large amount of information and share it with you. In contrast to last year, when the first positive results from BTKi studies and the new diagnostic criteria were two major innovations, this year there were not the big topics that were discussed. However, there were some interesting study results, especially in the session with the “late breaking news”.
Ocrelizumab in older and severely affected MS patients
Here, the so-called ORATORIO-Hand study, a phase IIIb study that investigated the effect of Ocrelizumab on hand function in primary progressive MS (PPMS), should be mentioned. Compared to the ORATORIO study, which led to the approval of Ocrelizumab for (early) PPMS a few years ago, the included MS patients were not only older but also more severely affected.
This is remarkable in that this was the first time a highly effective MS therapy (HET) was used in a controlled study setting in long-term and severely affected progressive MS patients. – So in a group that is rarely considered in study programs and is usually treated symptomatically rather than immunotherapeutically.
The primary endpoint of the study was disease progression based on a combined endpoint of hand function (measured with the 9-hole peg test) and EDSS. Compared to placebo, the risk of progression was reduced by 30%. If you separate by hand function and EDSS, the risk reduction for hand function progression was even 41%. The safety profile of Ocrelizumab also showed no new signals in this already older patient group.
The study is important because it ultimately proves that anti-inflammatory therapy can be useful in any phase of the disease and can hold positive aspects for MS patients. – Because if you need a wheelchair in everyday life, stable hand function can be of considerable importance.
Ocrelizumab in children and adolescents
Also on the opposite side of the disease spectrum, B-cell depletion will gain importance with ECTRIMS 2025. For the first time, the data from the OPERETTA II study were presented – a study that examined the effect of Ocrelizumab versus Fingolimod in pediatric MS. Fingolimod was the first highly effective therapy that was studied in childhood/adolescent MS a few years ago and has become a real “game changer” – especially given the fact that pediatric MS is highly inflammatory and often could not be adequately controlled with platform therapies.
In direct comparison, Ocrelizumab was now able to show that it is not inferior to Fingolimod. Given the study results with a about 48% risk reduction for clinical relapses compared to Fingolimod, B-cell depletion even seems superior – but the study was not powered for this statement. However, all secondary endpoints showed such a clearly better performance of B-cell depletion compared to Fingolimod that in the future it might be quite difficult to withhold B-cell therapy from children with highly inflammatory MS, especially since the safety profile of B-cell depletion was also acceptable in children.
Both studies therefore exemplify – and this is now a very stable finding – that we are now really good at controlling the inflammatory component/ focal inflammation of the CNS. But that is not yet the solution to the complex disease of multiple sclerosis – more on possible solutions in the next episode of my little congress report.
This post was translated from German to English with the help of AI.
