EAN 2026 | Can selected patients with multiple sclerosis safely discontinue ocrelizumab?

I really like this work that we have done there together with the colleagues from Giessen in Germany, namely Steffen Pfeuffer, because it addresses a really important question, I think. We are able to diagnose multiple sclerosis earlier and earlier and imagine a 20-year-old being diagnosed with multiple sclerosis today and with a life expectancy of about 80 years, you have to treat them for like 60 years. And doing so, we have to think about treatment sequences or other options on how we can treat our patient with MS-DMTs for this long time. And so we looked at our patients treated with ocrelizumab and of the 655 included in this study, we did a propensity score matching of 4 to 1 to address all important confounding factors. And after that, 58 patients discontinuing ocrelizumab and 232 patients moving forward on ocrelizumab were matched 4 to 1 against each other. In the first analysis, what we did was a survival analysis looking at different endpoints, looking at relapsing disease activity, MRI activity, combined inflammatory activity and also PIRA. And what we found was really, really interesting. In the first 24 months, the curve, the survival curve of the patient discontinuing ocrelizumab was above the patients continuing on ocrelizumab. Of course, these patients had to be stable to be included in the study for at least 12 months and had to be treated at least 12 months with ocrelizumab. And this was quite, despite this finding, this was quite really interesting. We didn’t expect that in the first place. But after 24 months, the curves switched. So the discontinuers were lower and at higher risk of recurrence of disease activity than the patients continuing treatment. However, for all the endpoints that we have chosen, MRI activity, combined inflammatory activity, relapse and PIRA, this difference was not statistically significant. The second thing that we want to look at in our study was the optimal treatment duration. And here we found in the overall cohort that after approximately 30 months of treatment, you don’t have any additional effect of going further with the treatment. On the other hand, the last analysis that we performed was on the optimal duration of the treatment interruption. And here we found that about 24 months would be suitable in some patients to stop the treatment. However, after 30 months, you anyhow had to re-initiate the treatment with ocrelizumab because after this the risk for disease activity increased numerically. So in conclusion what we find is that in a special set of patients on ocrelizumab treatment that have been treated for a distinct amount of time and in distinct conditions you can pause ocrelizumab treatment and thus maybe are able to treat patients with this DMT for a longer time, maybe for 10-20 years.

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