ResearchSpeak & #ThinkHand: ECTRIMS highlight ocrelizumab in PPMS

Ocrelizumab has a greater impact on protecting hand function than lower limb function #ThinkHand #ECTRIMS2016 #ResearchSpeak #MSBlog

"The poster below is another of my ECTRIMS highlightsAs you know the ocrelizumab in PPMS, or ORATORIO, trial was 'positive' in that ocrelizumab reduced disability progression on the EDSS, compared to placebo, by 25%. A lot of you have been quite down on this result saying it is not good enough and was driven by the inflammatory subgroup. This is not correct, but that is a debate for another time. Please remember incremental gains; 25% reduction over 2-3 years may end-up being >50% over 5-10 years." 


"What is more important is the observation that the impact of ocrelizumab treatment on upper limb function was even more impressive; nearly double (45%) that seen on the EDSS (25%) and timed-25-ft walk (27%). Why the difference in outcomes between lower and upper limbs? I have made the argument many time before that if you have lost reserve capacity in a particular system, which is the case in the lower limbs in PPMS, then it takes longer to see a positive outcome; i.e. therapeutic lag. However, if you have neuronal reserve in a pathway, in this case the arms and hands, then you get a read-out in relation to anti-inflammatory effects sooner and to a greater degree. These results are therefore compatible with our length-dependent axonopathy and therapeutic lag hypotheses and stress the importance of our current focus on arm & hand function as the primary outcome in progressive trials."


"I hope Roche are see the light and are tempted to do a trial in more advanced MS including a cohort of progressive MSers in wheelchairs. If I had PPMS I would want to be on ocrelizumab; I value my hand and arm function. The question is: 'Is the MS community brave enough to do trials in MSers who are already in wheelchairs?'. MSers want this; see our survey results which or overwhelming in favour of MSers wanting wheelchair users to be included in trials. If Pharma won't do it we will. Our challenge is to convince the world and to get funding in place to do our trial."



‘Now that I can’t walk, my hands and arms have become my legs….’

a person with MS


ProfG looking smug having just won a rosette for his poster!



CoI: multiple

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