What are the benefits and risks of ocrelizumab for multiple | Figure 1
%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)
Deleted account
Some actions are only available when you log in.
Report case
Report this to our moderators
What are the benefits and risks of ocrelizumab for multiple sclerosis?
You can view up to 4 cases without signing up Sign up for unlimited access
Key messages
– Ocrelizumab is a recently approved medicine to treat people with multiple sclerosis (MS). In relapsing‐remitting MS (where people experience flare‐ups of symptoms), ocrelizumab probably substantially reduces flare‐ups, may substantially reduce worsening of symptoms, and probably makes little or no difference to unwanted effects compared with interferon beta‐1a (a standard treatment for MS), 96 weeks after treatment starts.
– Compared to placebo after 120 weeks of treatment for primary progressive MS, ocrelizumab may reduce worsening of symptoms. Ocrelizumab probably increases unwanted effects but makes little or no difference to the number of serious unwanted effects.
– We need more, better‐designed studies.
We found four studies with 2551 people with MS. The largest study included 732 people and the smallest included 163 people. The studies were in countries around the world, but mostly in the USA. One study lasted for 24 weeks; two studies for 96 weeks; and one study for at least 120 weeks. Pharmaceutical companies funded the four studies.
Main results
Ocrelizumab compared with interferon beta‐1a for people with relapsing‐remitting MS, after 96 weeks of treatment:
– probably substantially reduces the number of people who had flare‐ups;
– may substantially reduce the number of people whose symptoms got worse;
– probably makes little or no difference to unwanted effects; and
– may substantially reduce the number of people who stopped having treatment due to unwanted effects.
Ocrelizumab compared with placebo for people with primary progressive MS, after 120 weeks of treatment:
– may reduce the number of people whose symptoms got worse;
– probably increases unwanted effects; and
– may make little or no difference to the number of serious unwanted effects and the number of people who stopped having treatment due to unwanted effects.
Our confidence in the results is moderate to low for several reasons. First, people dropped out of the studies unevenly, which meant more people had one treatment than the other. Second, there was not enough information about some of our points of interest to allow us to draw conclusions for outcomes. Finally, changes in symptoms shown by scans could have been due to causes other than disease progression.
More about this case
ResolvedCommon presentationTrending
Why you should join Figure 1
Share your knowledge with our global community of healthcare professionals
Get help from experts in your field
Learn from our library of real-world cases and quizzes
Similar cases
\ \ What are the benefits and risks of drugs acting on the immune system to treat relapsing‐remitting multiple sclerosis?\ Key messages\ ‐ After two years of treatment, natalizumab, cladribine and alemtuzumab work best in reducing the frequency of relapses in relapsing‐remitting multiple sclerosis. Natalizumab is likely to be also effective in slowing the progression of disability after two years of treatment.\ ‐ Longer studies are needed to assess the benefits and harms of drugs acting on the immune system for relapsing‐remitting multiple sclerosis.\ ‐ Future research on these types of drugs should compare them against each other and focus on effects that are important to people with multiple sclerosis, such as their quality of life and their ability to think, learn, remember, use judgement, and make decisions.\ What did we find?\ We found 50 studies with 36,541 people with multiple sclerosis (68.6% female and 31.4% male) treated with a "disease‐modifying" drug for at least one year. The biggest study included 2,244 people; the smallest included 19 people. The studies were conducted all over the world, mostly in the USA and Europe. Most studies lasted 12 or 24 months; only eight studies lasted more than 24 months. Most studies were performed by pharmaceutical companies in order to obtain authorisation from regulatory authorities for marketing the studied drug. Twenty‐five studies compared a "disease‐modifying" drug with no treatment; the other studies compared two different types of "disease‐modifying" drugs. We are highly confident that natalizumab, cladribine and alemtuzumab are more effective than most drugs in reducing the frequency of relapses after two years of treatment. We are moderately confident that natalizumab is also likely to be effective in slowing the worsening of disability after two years of treatment. We are moderately confident that people taking fingolimod, teriflunomide, glatiramer acetate, interferon beta‐1a, laquinimod, natalizumab and daclizumab are more likely to discontinue the drug because of unwanted effects.\ Limitations of the evidence\ Our confidence in the desirable and undesirable effects of "disease‐modifying" drugs is limited, mainly because the evidence is based on few cases of relapses and worsening of disability, and because we were concerned that the interests of pharmaceutical companies may have had an influence.](https://app.figure1.com/case-detail/01821d40-e866-4bff-98ee-8c0db01dcb60)
\ \ For people with multiple myeloma, bisphosphonates probably make little or no difference to overall survival and may make little or no difference to disease progression-free survival.\ Bisphosphonates probably reduce vertebral fractures but not non-vertebral fractures.\ Bisphosphonates probably reduce skeletal related incidents (e.g. compression of the spinal cord).\ Whether or not bisphosphonates alleviate pain is uncertain.\ Overall, for every 1000 patients treated with bisphosphonates, about one patient will suffer from the osteonecrosis of the jaw.\ Cochrane review; 24 studies with 7293 patients with multiple myeloma, comparing bisphosphonates with placebo or no treatment.](https://app.figure1.com/case-detail/097b62e9-82e1-4c6c-abf6-6f38b0708848)
\ \ Key messages\ • Overall, we did not find sufficient evidence to show that medicines that block interleukin‐1 are effective treatments for people with COVID‐19, or whether they cause unwanted effects.\ • We found 16 studies with unpublished results. We will update this review when new data are available.\ • In future, we need high‐quality studies to evaluate medicines that block interleukin‐1 to treat COVID‐19.\ We wanted to know if IL‐1 blockers are effective treatments for people with COVID‐19, compared with standard care alone or with placebo.\ We searched for studies that assessed the effects of IL‐1 blockers to treat people with COVID‐19 compared with standard care alone or with placebo.\ We found six studies with 2132 people. Four studies assessed anakinra (1633 people) and two assessed canakinumab (499 people). People were aged between 58 - 68 years old on average, and the majority were men. All the people were in hospital, mainly with moderate to critical COVID‐19. The studies varied in size, from 45 to 2253 people. At the start of the studies, 67% to 100% of people were receiving oxygen, and 0% to 33% were on a ventilator.\ Compared to usual care and placebo:\ • Anakinra probably results in little or no improvement in COVID‐19 symptoms at 28 days after treatment (three studies, 837 people) but we do not know if it makes a difference at 60 days (one study, 115 people).\ • We do not know if anakinra makes a difference to the number of deaths at 28 days after treatment (two studies, 722 people) or at 60 days (four studies, 1633 people).\ • Anakinra probably results in little or no increase in any unwanted effects at 28 days after treatment, but we are not sure about its effect on serious unwanted effects (two studies, 722 people).\ Compared to usual care and placebo:\ • Canakinumab probably results in little or no improvement in COVID‐19 symptoms (defined as improvement on a clinical scale or discharge from hospital) at 28 days after treatment (two studies, 499 people).\ • We do not know if canakinumab makes a difference to the number of deaths at 28 days after treatment (two studies, 499 people) or at 60 days (one study, 45 people).\ • Canakinumab probably results in little or no increase in any unwanted effects (one study, 454 people), but we are not sure about its effect on serious unwanted effects (two studies, 499 people) at 28 days.](https://app.figure1.com/case-detail/6f766bf4-7195-4899-82ce-0ed7ace9a9d0)
\ \ Alemtuzumab for multiple sclerosis (MS)\ Key messages\ – Alemtuzumab may reduce the risk of relapse and disease progression when compared to subcutaneous interferon beta‐1a in people with relapsing–remitting MS, a type of MS where you have worsened symptoms (relapses) followed by a recovery period (remitting).\ – Future well‐designed studies are needed to assess patient‐related outcomes such as quality of life and fatigue.\ What did we want to find out?\ We aimed to investigate the benefits and adverse events of alemtuzumab used alone or associated with other treatments for people with any form of MS. We wanted to find out if alemtuzumab was better compared to other available treatments for people with MS.\ What did we find?\ We found three studies (including 1713 participants) that fulfilled the review selection criteria. All studies compared intravenous (injected into a vein) alemtuzumab versus subcutaneous (injected under the skin) interferon beta‐1a for people with relapsing–remitting MS. Two studies (called CARE‐MS I and CAMMS223) were treating the participants for their MS the first time (treatment‐naive). The third study (CARE‐MS II) included participants with at least one relapse while being treated with interferon beta or glatiramer acetate for at least six months.\ Main results\ The review of these studies found that, compared to subcutaneous interferon beta‐1a, alemtuzumab may reduce the risk of relapse and disease progression (worsening of the MS) in people with relapsing–remitting MS, and make little to no difference in the proportion of participants with at least one adverse event (but both medicines had a high proportion of participants with at least one adverse event). There is a lack of information about the effects of alemtuzumab on other outcomes such as quality of life and fatigue.\ What are the limitations of the evidence?\ Our confidence in the effects of alemtuzumab, compared to interferon beta‐1a, for the main outcomes ranges from low to very low. This means that there is a high probability that future studies could change our conclusions.](https://app.figure1.com/case-detail/9ea07ecc-e465-412c-9bdd-ed40f96c3bcb)
Trending now
\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)
\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)
\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)
\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)