It wasn’t long ago that there were no treatments for multiple sclerosis.
In the 1970s, some doctors used chemotherapy to treat the degenerative neurological disease. Since then, more than a dozen drugs have been developed or approved, including infusions, oral medications and self-administered shots.
None of these are a magic bullet for a disease that can be disabling and deadly. But now there is a new drug, Ocrevus, that looks like a game-changer. It uses a novel approach to blocking the inflammation that drives the disease and looks as if it’s spectacularly effective. It also costs $65,000 a year.
I have MS. Should I take Ocrevus?
That, I discovered, is not a simple question to answer. But because I’m an MS patient and a science journalist, I was determined to try to figure it out.
In March, the FDA approved Ocrevus (ocrelizumab) for the treatment of relapsing-remitting multiple sclerosis, the most common form of the disease. People with RRMS tend to have flare-ups when their symptoms worsen, followed by periods of remission and, in some cases, a full or partial recovery.
In two clinical trials sponsored by the drug’s eventual manufacturer, F. Hoffmann-La Roche, RRMS patients who were given ocrelizumab had about 50 percent fewer relapses and up to 95 percent fewer new lesions on the brain and spinal cord than those who were given Rebif, a common therapy.
MS is an autoimmune disease, meaning the body attacks itself. The body’s nerve endings and the fatty tissue that coats them, called myelin, bear the brunt of the immune system’s attacks. As a result, the central nervous system has difficulty communicating with the nerves, leading to a disease that manifests itself in different ways, such as pain, fatigue, disability and slurred speech.
Historically, treatment of MS has focused on changing the way T cells, a type of white blood cell, decide which “foreign materials” to attack. “That’s why the pathway to B cell therapy took so long,” says Dr. Stephen Hauser, who has studied MS for decades and led two key clinical trials to test Ocrevus. He chairs the department of neurology at the University of California, San Francisco School of Medicine.
B cells, which are less numerous than T cells, are a different type of white blood cell involved in fighting infection, and these are the cells that Ocrevus targets. “Now that we look back,” Hauser says, “we know that all of the other therapies work against B cells also. They are not selective for T cells.” The fact that the previous therapies worked, Hauser says, was “fortuitous.”