Treatment history and disease-modifying therapy (DMT) drivers have been shown to vary among patients with multiple sclerosis (MS) who recently were switched to different anti-CD20 agents, according to study results presented at the 2022 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) held from June 1-4, in National Harbor, Maryland.

The researchers sought to compare switch treatment patterns and therapy selection decisions among DMTs with an anti-CD20 mechanism of action (MOA). A total of 233 US neurologists completed the survey and provided the necessary data. The analyses were focused on switching to ocrelizumab (n=144), ofatumumab (n=47), and branded or biosimilar rituximab (n=41).

A cross-sectional analysis of medical record data from patients with MS who had switched to a new DMT between January 28, 2021, and March 1, 2021, within the prior 3 months was conducted.


Continue Reading

Overall, 65% of the switches to ocrelizumab and 63% of the switches to rituximab were from first-line DMTs. Switches to ofatumumab, in contrast, were typically from first-line or second-line DMTs (43% vs 49%, respectively).

Patients who were switched to rituximab often had been taking a generic DMT (29%) or interferon (29%). Approximately half of the switches to ocrelizumab were among participants who had been taking an oral DMT — most often dimethyl fumarate (23%) or fingolimod (15%). Those individuals switching to ofatumumab frequently had been taking other monoclonal antibodies (36%) — most often ocrelizumab (21%).

For each of the anti-CD20 DMTs, the desire for a high-efficacy agent (ocrelizumab: 57%; ofatumumab: 51%; rituximab: 56%) and the MOA of the agent (ocrelizumab: 54%; ofatumumab: 53%; rituximab: 44%) were key reasons for making the change.

With ocrelizumab, its unique indication for primary progressive MS played an important role in the choice of DMT (23%). Administration-type preference (40%), perception that a patient was highly compliant with medical instructions (36%), COVID-19 pandemic–appropriate option (9%), and starter kit availability (7%) were the main reasons for choosing ofatumumab as the DMT. Rituximab selection was impacted by physicians’ comfort/familiarity with the agent (36%), low patient cost (26%), payer preference (21%), and no or low monitoring requirement burden (21%).

If a patient’s current DMT had not been available at the time of prescribing, common alternative treatment options included other anti-CD20 agents (ocrelizumab: 41%; ofatumumab: 42%; rituximab: 33%). Among patients currently being treated with ofatumumab, the subcutaneous DMT was chosen instead of infused ocrelizumab,  because of better convenience (67%) and preferred administration method (44%). Rituximab was chosen instead of ocrelizumab because of expectations that the patient copay would be lower (62%) and there would be fewer managed care hassles (46%).

The researchers concluded that among the anti-CD20 agents evaluated, “[ofatumumab] is more likely to be used later line compared with [ocrelizumab] and among patients where the once-monthly subcutaneous dosing profile was influential in the switch decision. [Branded or biosimilar rituximab], used off label for the treatment of MS, was used in place of [ocrelizumab] when market access was a concern” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference 

McFadden E, Schobel VR. Treatment patterns and therapy selection drivers comparison between anti-CD20 agent among patients with multiple sclerosis who recently switched disease-modifying therapy. Presented at: CMSC 2022 Annual Meeting; June 1-4, 2022; National Harbor, Maryland. Abstract DMT26.