168. Ocrelizumab in Real Clinical Practice of one Municipal Clinical Hospital in Moscow: Experience of Prescription, Safety and Efficacy Problems

• Published in: Multiple sclerosis and related disorders 2024-12, Vol.92
• Main Authors: Kukushkina, Anna, Lysogorskaia, Elena, Ponevezhskaia, Ekaterina, Davydovskaia, Maria
• Format: Article
• Language: English
• ISSN: 2211-0348
• DOI: 10.1016/j.msard.2024.106129

The experience of Ocrelizumab administration is rapidly growing. But real world practice differs from clinical trials depending on the country and its Healthcare system, patient population and their perceptions.Therefore, it presents new challenges. We analyzed 136 cases of Ocrelizumab prescribing in our hospital. Patients population: 51% remitting multiple sclerosis, 49% progressive multiple sclerosis. The maximum duration of Ocrelizumab administration was 4 years (in treatment 15%). All patients completed an anonymised online questionnaire. The survey questions were about employment, physical activities, possible infections, vaccination, primarily COVID-19, as well as their subjective assessment of disease progression and ocrelizumab efficacy. The objective assessment was based on data obtained at routine visits to the outpatient department for MS patients. During the follow-up period, 1 death was registered in a patient with COVID-19 infection. 1 pregnancy was registered, which resulted in the drug administration. One patient was diagnosed with an ovarian cyst, which did not require changing the medication regimen. There were no patient-initiated discontinuations of ocrelizumab. Frequent adverse events reported both by patients themselves and confirmed by referrals to other specialists included infections, pain (headache, muscle, joint pain), skin reactions, including pruritus, and infusion reactions. Of the 136 patients receiving Ocrelizumab, 86 patients (63%) participated in the anonymised questionnaire. Majority of respondents rated the therapy as an effective intervention. A number of patients reported treatment as ineffective, which was associated not only with disease progression, but also with unreasonable expectations of medication. One in five patients didn't seek medical attention despite experiencing health issues. So, it may be worthwhile to recommend not only vaccination against chickenpox, but also be proactive against pneumococcal infection, measles, Haemophilus influenzae. It is important to correlate patients' subjective opinion about the effectiveness of the medication with their level of physical activity, workload and motivation for functional rehabilitation. The patients' belief that “the Ocrelizumab is effective, gives an energy, but the closer the next infusion, the less strength there is”. This opinion seems to be an interesting observation and probably requires additional objective assessment and further explanation of their bel