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Ocrevus, Hope and a Suicide Postponed

Several months ago, I wrote a column in Multiple Sclerosis News Today about Andrew Barclay.

Barclay died in an assisted suicide in December. He’d had multiple sclerosis for many years.

Colin Campbell is a 56-year-old MS patient who lives in Inverness, Scotland. He also wanted to die. In fact, he was scheduled to end his own life, with help, on June 15 at a suicide clinic in Switzerland. But he changed his mind.

Campbell has been writing about his MS for the Sunday Herald in Glasgow since late April. (He’s also the paper’s “Beer of the Week” writer.) He describes himself as “a man on death row,” and on May 20, his MS article began, “Well, unfortunately I am still alive.”

Campbell has mobility problems, and living in a second-floor flat has been tough for him. He says he’s had no support in getting ground-floor accommodations. He complains that he was recently discharged from a hospital without the possibility of receiving home care. He has no caregivers and exists on microwave dinners.

Campbell had hoped that a stem cell transplant would allow him to live a life that was worth living, but his neurologist told him that he thought HSCT would be too risky. So, at age 56, Campbell made plans to die.

Then came a glimmer of hope. In a column he wrote two days after he had been planning to die, Campbell explained that a former police sergeant named Rona Tynan gave him a reason to live, at least a little while longer.

“Rona, who also has multiple sclerosis, was of the opinion that I should not commit suicide until having tried every other possible avenue – including soon-to-be-available multiple sclerosis treatments for folk like me with primary progressive MS. Rona persuaded me, and I agreed,” Campbell wrote.

That treatment is the disease-modifying drug ocrelizumab, sold in the U.S. under the brand name Ocrevus. The U.S. Food and Drug Administration approved it a few months ago, and it’s the only drug approved to treat progressive MS. Some neurologists refer to it as “stem-cell lite” because of the way it attacks the rogue B-cells that are believed to cause MS. Ocrelizumab is expected to be available in Scotland later this year.

“For the first time since multiple sclerosis was identified during a post-mortem 149 years ago, there now seems to be a real hope of lasting risk-free treatment for multiple sclerosis sufferers within the next few years,” Campbell writes. “The timing could not have been more perfect — although there was a fear, of course, that the developments had just come too late for me. But I wanted to remain as optimistic as possible.”

Colin Campbell’s hope, now, is that Ocrevus will halt the progression of his MS and avoid a future that he pictures as becoming bedridden, needing help to eat and bathe, and using a catheter. He’s not sure how much hope he realistically should have, but he ends his June 17 column with: “Wish me well.”

That, we certainly do.


(This post first appeared as my regular column on www.multiplesclerosisnewstoday.com)


Good Test Results for Primary-Progressive MS Drug Ocrelizumab

My neurologist tells me “the buzz is good” about ocrelizumab.

The investing web site Motley Fool calls it “the revolutionary Multiple Sclerosis drug you’ve never heard of.”

Ocrelizumab, which Genentech hopes to market under the name Ocrevus, is special because it’s designed to treat primary-progressive, as well as relapsing-remitting, MS.

How does it work?

I’m not a scientist, but after reading a lot of scientific writing here’s my best attempt to ‘splain it in “people-speak.”  (I’ve linked to some of these reports in case you want to wade through yourself).

B-cells are white blood cells that create infection-fighting antibodies. In MS patients some of these B-cells carry abnormal antibodies. Scientists believe these “rogue” B-cells play a role in the way the immune system attacks the brain and spinal cord tissues in MS patients.Ocrelizumab diagram crop

Ocrelizumab binds to a molecule called CD20 on the surface of B cells and depletes those cells from the circulation. The result appears to be a reduction in MS activity while still leaving the immune system capable of fighting off infections such as PML, a very dangerous potential side effect of the current group of powerful MS drugs.

Ocrelizumab is similar to rituximab, marketed as Rituxam, in the way it works. But rituximab is a CD20 antibody that is derived from mice and humans.  Ocrelizumab is derived from humans.

Encouraging test results

Genentech recently announced encouraging results from a Phase 3 study of 732 primary-progressive MS patients.  Ocrelizumab was administered intravenously; two infusions given two weeks apart every six months. The results showed that the drug reduced the risk of disease progression, as measured by the Expanded Disability Status Scale (EDSS), by 24-25 percent compared to a placebo.  MRIs also showed a large 17 percent reducti0n in the rate of brain volume loss.

Data from two related Phase 3 studies, testing the efficacy of ocrelizumab in 1,656 patients with relapsing forms of MS, found that it was superior to interferon beta-1a, reducing the annualized relapse rate by nearly 50 percent over two-years of treatment.

What’s next?

This past February the Food and Drug Administration designated ocrelizumab a Breakthrough Therapy for use as a possible primary-progressive MS treatment.  That designation allows quicker drug development and FDA review.

Roche says ocrelizumab is the first investigational medicine to show very positive results with both primary-progressive and relapsing-remitting MS patients. The company says it plans to submit data from all three studies to the FDA this year.  If so, it’s possible there could be FDA action on the drug by the end of the year.


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