GenentechsOcrevus(ocrelizumab) continues to be the most prescribed medication to reduce inflammatory disease in people with active secondary progressive multiple sclerosis(SPMS) amongU.S. neurologists, even though NovartisMayzent(siponimod) and EMD SeronosMavenclad(cladribine) were approved in March to treat this same MS group, according to a 2019 report bySpherix Global Insights.

Ocrevus, the only treatment approved for primary progressive MS, is also the choice for delaying disability progression in people with PPMS.

But Spherixs latest report, titled RealWorld Dynamix: Progressive Forms of Multiple Sclerosis (US) and based on asurvey of 157 U.S. neurologists and prescription data they provided, suggests that Mayzent and Mavenclad are gaining on Ocrevus for active SPMS patients.

Mayzent and Mavencladwere the first MS therapies whose U.S. Food and Drug Administration (FDA) approvals explicitly included both active SPMS and relapsing-remitting MS (RRMS) under the umbrella of relapsing MS forms.

Older MS medications subsequently had updates to their labels as well, adding clinically isolated syndrome (CIS) and active SPMS indications to be consistent with the revised definition of relapsing MS.

Possibly influenced by these updates, a shift appears to be underway in how neurologists identify and treat active SPMS patients. These doctors were more likely to estimate that patients had transitioned from RRMS to SPMS in 2019 than they were in last years report.

According to a press release summarizing the report, a majority of neurologists surveyed (more than two-thirds) are now confident they can tell if an RRMS patient is transitioning. Compared to one year ago, more are also likely to agree that relapsing MS treatments are effective for active SPMS.

SPMS patients continue to switch their medications mostly due to efficacy concerns, especially in terms of disability progression, the report showed. Many patients switch from an injectable, such asTevas Copaxone(glatiramer acetate) or Biogens Tecfidera (dimethyl fumarate). The use of Mayzent already the second most-preferred therapy for active SPMS and biologics (monoclonal antibodies) for these patients has been raising as well.

In fact, neurologists said they favor Mayzent, Mavenclad, or Sanofi Genzymes Lemtrada (alemtuzumab) when a next-line switch is needed in people with active SPMS. (Mavenclads approval came with a general recommendation that it be a second-line therapy option.) This trend will likely weigh on Ocrevus in this patient group.

Nonactive, or non-relapsing, SPMS is currently the MS type with the greatest unmet need. No approved therapies exist for these patients, in stark contrast to those with other disease types.

Several companies are trying to fill this gap, with clinical development programs ongoing in several investigational treatments. But neurologists remain skeptical about their likely success.

MedDay Pharmaceuticals Qizenday (MD-1003, high-dose biotin), AB Sciences masitinib, and MediciNovas ibudilast are either in or readying Phase 3 trials for nonactive SPMS.

Pivotal trials for MD-1003(NCT02936037) and masitinib (NCT01433497) are fully enrolled, while ibudilasts trial has yet to launch.

MediciNovaannounced that its Phase 3 study aiming for ibudilasts approval would enroll only SPMS patients without relapses, clearly focusing on the high need for therapies here.

However, the neurologists surveyed did not appear to see much value in potential treatments for nonactive SPMS, largely comfortable with off-label therapies. Clinical trials for this SPMS population will need to show compelling data to convince the medical community these treatments effectively slow disability progression in the absence of ongoing inflammation.

Novartis Gilenya (fingolimod) is currently more favored for nonactive MS patients than Ocrevus, possibly indicating that neurologists will want to transition patients to Mayzent.

Both Mayzent and Gilenya belong to the same class of medications, that ofsphingosine 1-phosphate (S1P) receptormodulators. Ocrevus works through a differentmechanism, inducing immune B-cell depletion.

Ana is a molecular biologist with a passion for discovery and communication. As a science writer she looks for connecting the public, in particular patient and healthcare communities, with clear and quality information about the latest medical advances. Ana holds a PhD in Biomedical Sciences from the University of Lisbon, Portugal, where she specialized in genetics, molecular biology, and infectious diseases

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Patrcia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites.

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Ocrevus Top Choice of US Neurologists for Active SPMS, But Mayzent and Mavenclad Gaining Interest, Report Says - Multiple Sclerosis News Today