Optimal treatment revealed for patients switching from Biogen multiple sclerosis drug

Pharma News: For the first time Australian researchers have identified a crucial treatment pathway for individuals living with multiple sclerosis (MS) who are at risk of a serious brain infection.

The study, published in JAMA Neurology sheds light on the optimal alternative medication for MS patients who currently rely on Biogen’s Tysabri (natalizumab) but face the peril of developing progressive multifocal leukoencephalopathy (PML), a potentially deadly brain infection caused by the John Cunningham virus (JCV).

While the risk of PML is relatively small, the prognosis is grim, with an average life expectancy of just six months. This statistic has prompted many patients undergoing regular blood monitoring to consider switching treatments. However, discontinuing Tysabri can leave patients vulnerable to severe MS relapses, presenting them with a challenging dilemma. Until now, the medical community has remained uncertain about the most effective alternative drug for these patients.

The researchers conducted a comprehensive analysis of real-world data collected from the international MSBase registry, housed in the Central Clinical School, Monash University Alfred Hospital Campus, which tracks outcomes in over 89,000 patients worldwide. Among the vast pool of patients, they pinpointed 1386 individuals who had transitioned from Tysabri to other therapy options.

Among the alternative medications examined – dimethyl fumarate, Novartis’ Gilenya (fingolimod), and Roche’s Ocrevus (ocrelizumab) – Ocrevus emerged as the most effective treatment for patients who had ceased Tysabri. The study revealed that Ocrevus exhibited lower relapse risks and discontinuation rates compared to dimethyl fumarate and Gilenya.

Dr Chao Zhu, the first author of the study from the Monash University Central Clinical School’s Department of Neuroscience, expressed the global significance of these findings for both clinicians and patients. He emphasised that the results could provide crucial guidance for treatment decisions, empowering healthcare providers to devise optimal strategies for patients who need to discontinue Tysabri.

Highlighting the challenges faced by some countries in accessing newer and more effective drugs, Dr Zhu commented, “Some countries have limited treatment options available due to the high costs to produce some of the newer, more effective drugs or have strict guidelines on what can be used as first-line treatment, or some cannot be used if women intend on childbearing.”

Professor Helmut Butzkueven, the senior author of the study from the Monash University Central Clinical School Department of Neuroscience and The Alfred’s Department of Neurology, stressed the importance of diligent monitoring for JCV risk using a blood test among MS patients. He empathised with the anxiety and distress experienced by patients who must change their medication from Tysabri. Professor Butzkueven highlighted the study’s potential to facilitate better-informed decisions for both neurologists and patients navigating this challenging transition.

The study’s findings serve as a beacon of optimism, offering healthcare professionals and individuals battling MS the tools needed to make well-informed choices and forge a path towards better outcomes.

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