Roche’s OCREVUS® (ocrelizumab) gains positive CHMP opinion

 

Roche’s OCREVUS® (ocrelizumab) gains positive CHMP opinion for relapsing forms of multiple sclerosis and primary progressive multiple sclerosis

  • If approved, OCREVUS will be an important treatment option for people with active relapsing forms of multiple sclerosis (RMS) showing superior efficacy on three major markers of disease activity and disability progression compared with Rebif (interferon beta-1a)
  • If approved, OCREVUS will be the first and only medicine for people in the European Union (EU) with primary progressive multiple sclerosis (PPMS)

 

Roche (SIX: RO, ROG; OTCQX: RHHBY) announced today that the Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion for the use of OCREVUS for people with active relapsing forms of multiple sclerosis defined by clinical or imaging features and for people with early primary progressive multiple sclerosis in terms of disease duration and level of disability, and with imaging features characteristic of inflammatory activity. In Europe, multiple sclerosis (MS) affects approximately 700,000 people and the majority have a relapsing form of MS or primary progressive MS at diagnosis.[i],[ii]

“Today’s positive recommendation for OCREVUS is great news for people in Europe with active relapsing forms of MS as well as those with early primary progressive MS, who are all now one step closer to having this important new treatment option,’’ said Sandra Horning, M.D., Roche’s Chief Medical Officer and Head of Global Product Development. “We are pleased that the CHMP has recognised the clinical significance of the OCREVUS data, particularly for people living with primary progressive MS, a highly disabling disease that currently has no approved treatments in Europe.’’

The positive CHMP opinion is based on data from three pivotal Phase III studies, which met primary and key secondary endpoints.  Data from two identical Phase III studies in relapsing forms of MS (OPERA I and OPERA II) showed OCREVUS demonstrated superior efficacy on reducing the number of attacks (relapses) per year by nearly half and significantly slowed progression of the disease compared with high-dose interferon beta-1a (Rebif®) over the two-year controlled treatment period. OCREVUS also significantly increased the chance of a patient having no evidence of disease activity (brain lesions, relapses and worsening of disability).

In a separate PPMS Phase III study (ORATORIO), OCREVUS was the first and only treatment to significantly slow disability progression and reduce signs of disease activity in the brain (MRI lesions) compared with placebo with a median follow-up of three years.

The most common side effects associated with OCREVUS in all Phase III studies were infusion reactions and upper respiratory tract infections, which were mostly mild to moderate in severity.

Based on this positive CHMP opinion, a final decision from the European Commission regarding the approval of OCREVUS is expected in the coming months. Following this decision, OCREVUS will then be granted marketing authorisation that will be valid in all 28 member states of the European Union.

OCREVUS has been approved for use in countries across North America, South America, the Middle East, Eastern Europe, as well as in Australia and Switzerland. Approximately 20,000 patients have been treated with OCREVUS to date.

 

About OCREVUS (ocrelizumab)

OCREVUS is a humanised monoclonal antibody designed to target CD20-positive B cells, a specific type of immune cell thought to be a key contributor to myelin (nerve cell insulation and support) and axonal (nerve cell) damage. This nerve cell damage can lead to disability in people with multiple sclerosis (MS). Based on preclinical studies, OCREVUS binds to CD20 cell surface proteins expressed on certain B cells, but not on stem cells or plasma cells, and therefore important functions of the immune system may be preserved.

OCREVUS is administered by intravenous infusion every six months. The initial dose is given as two 300 mg infusions given two weeks apart. Subsequent doses are given as single 600 mg infusions.

 

About the OPERA I and OPERA II studies in relapsing forms of MS

OPERA I and OPERA II are Phase III, randomised, double-blind, double-dummy, global multi-centre studies evaluating the efficacy and safety of OCREVUS (600 mg administered by intravenous infusion every six months) compared with interferon beta-1a (44 mcg administered by subcutaneous injection three times per week) in 1,656 people with relapsing forms of MS. In these studies, relapsing MS (RMS) was defined as relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) with relapses. A similar proportion of patients in the OCREVUS group experienced serious adverse events and serious infections compared with patients in the high-dose interferon beta-1a group in the RMS studies.

 

About the ORATORIO study in primary progressive MS

ORATORIO is a Phase III, randomised, double-blind, global multi-centre study evaluating the efficacy and safety of OCREVUS (600 mg administered by intravenous infusion every six months; given as two 300 mg infusions two weeks apart) compared with placebo in 732 people with primary progressive MS (PPMS). The blinded treatment period of the ORATORIO study continued until all patients had received at least 120 weeks of either OCREVUS or placebo and a predefined number of confirmed disability progression (CDP) events was reached overall in the study. A similar proportion of patients in the OCREVUS group experienced adverse events and serious adverse events compared with patients in the placebo group in the PPMS study.

 

About multiple sclerosis

Multiple sclerosis (MS) is a chronic disease that affects an estimated 2.3 million people around the world, for which there is currently no cure.[iii],[iv] MS occurs when the immune system abnormally attacks the insulation and support around nerve cells (myelin sheath) in the brain, spinal cord and optic nerves, causing inflammation and consequent damage. This damage can cause a wide range of symptoms, including muscle weakness, fatigue and difficulty seeing, and may eventually lead to disability.[v],[vi],[vii] Most people with MS experience their first symptom between 20 and 40 years of age, making the disease a leading cause of non-traumatic disability in younger adults.

Relapsing-remitting MS (RRMS) is the most common form of the disease and is characterised by episodes of new or worsening signs or symptoms (relapses) followed by periods of recovery.[viii],[ix] Approximately 85 percent of people with MS are initially diagnosed with RRMS.[x] The majority of people who are diagnosed with RRMS will eventually transition to secondary progressive MS (SPMS), in which they experience steadily worsening disability over time.10
Relapsing forms of MS (RMS) include people with RRMS and people with SPMS who continue to experience relapses. Primary progressive MS (PPMS) is a debilitating form of the disease marked by steadily worsening symptoms but typically without distinct relapses or periods of remission.2 Approximately 15 percent of people with MS are diagnosed with the primary progressive form of the disease.10

People with all forms of MS experience disease activity – inflammation in the nervous system and permanent loss of nerve cells in the brain – even when their clinical symptoms aren’t apparent or don’t appear to be getting worse.[xi] An important goal of treating MS is to reduce disease activity as soon as possible to slow how quickly a person’s disability progresses.[xii] Despite available disease-modifying treatments (DMTs), some people with RMS continue to experience disease activity and disability progression.


References

[i] European Multiple Sclerosis Platform. MS Facts. Available at: http://www.emsp.org/about-ms/

[ii] Multiple Sclerosis International Federation. Types of MS. Available at https://www.msif.org/about-ms/types-of-ms/.

[iii] National Institutes of Health-National Institute of Neurological Disorders and Stroke. Multiple Sclerosis: Hope Through Research. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Multiple-Sclerosis-Hope-Through-Research. 

[iv] Multiple Sclerosis International Federation. (2013). Atlas of MS 2013. Available at: http://www.msif.org/about-us/advocacy/atlas/.

[v] Ziemssen T. (2005). Modulating processes within the central nervous system is central to therapeutic control of multiple sclerosis. J Neurol, 252(Suppl 5), v38-v45. 

[vi] Hauser S.L. et al. (2012). Multiple sclerosis and other demyelinating diseases. In Harrison’s Principles of Internal Medicine (pp.3395-3409). New York, NY: McGraw Hill Medical. 

[vii] Hadjimichael O. et al. (2007). Persistent pain and uncomfortable sensations in persons with multiple sclerosis. Pain, 127(1-2):35-41. 

8Lublin F.D., Reingold S.C. (1996) Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology, 46(4):907–11. 

9Lublin F.D. et al. (2014). Defining the clinical course of multiple sclerosis. Neurology, 83(3):278-86. 

10National Multiple Sclerosis Society. Types of MS. Available at http://www.nationalmssociety.org/What-is-MS/Types-of-MS. 

11Erbayat A, et al. (2013). Reliability of classifying multiple sclerosis disease activity using magnetic resonance imaging in a multiple sclerosis clinic. JAMA Neurol, 70(3):338-44. 

12MS Brain Health. Time Matters in Multiple Sclerosis. Available at http://msbrainhealth.org/perch/resources/time-matters-in-ms-report-may16.pdf.