Article updated on:
October 24, 2023
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While there is no cure for MS, there are effective disease-modifying therapies (DMTs) that can manage symptoms and slow progression.
Two of the newer DMTs approved for treating relapsing forms of MS are Mavenclad and Ocrevus.
Both have demonstrated robust efficacy in clinical trials, but they differ significantly in mechanisms of action, administration, safety profiles, and approved indications. This article aims to provide a comprehensive comparison to help patients make an informed choice.
Mavenclad (cladribine) is an oral DMT taken over two short annual courses spanning 2 years. Initially approved by the European Medicines Agency in 2017, Mavenclad targets and depletes certain immune cells responsible for MS inflammation and damage.
Administration and Dosing
Mavenclad is taken orally in 10mg tablets, requiring just two annual 4-5 day treatment courses. These short courses provide 2 years of disease control, making it convenient for those looking to minimize medical visits.
Efficacy and Safety
Mavenclad has shown significant promise in reducing disease activity, including a 58% reduction in the annualized relapse rate compared to placebo. However, it does come with a black box warning for potential increased risk of malignancy and is contraindicated in pregnant women.
Ocrevus (ocrelizumab) is a monoclonal antibody therapy administered by intravenous infusion every 6 months. It was approved by the FDA in 2017 for both relapsing and primary progressive forms of MS.
Administration and Dosing
Ocrevus is administered as an intravenous infusion, requiring a medical facility visit every 6 months. While this might be less convenient than oral administration, some patients prefer the less frequent dosing.
Efficacy and Safety
Ocrevus has proven to be highly effective, reducing disability progression by 40% in primary progressive MS patients. However, it may increase the risk of infections due to its immunosuppressive effects.
When it comes to reducing disease activity in relapsing forms of multiple sclerosis (RRMS), both Mavenclad and Ocrevus have proven to be robust options. Clinical trials indicate that Ocrevus leads to a marginally higher reduction in the annualized relapse rate compared to Mavenclad—achieving a 58% reduction as opposed to Mavenclad's 47% when compared to an active comparator. Additionally, both medications have shown promise in reducing confirmed disability progression by approximately 40% in contrast to either a placebo or an active comparator.
Long Term Efficacy
In terms of long-term outcomes, Ocrevus has a slight edge. After two years of treatment, a higher proportion of patients using Ocrevus remained relapse-free (89%) compared to those on Mavenclad (67%). When evaluating MRI lesion activity, another critical metric, both drugs performed exceptionally well. Mavenclad decreased active lesions by 80%, whereas Ocrevus outperformed it by reducing them by 95% when compared to Rebif.
Despite the measurable differences in efficacy metrics, both medications provide substantial benefits, such as reductions in relapse rates, disability progression, and MRI lesions. While some experts posit that Ocrevus' stronger performance in clinical trials could indicate superior long-term disability prevention, real-world data affirms that both medications are highly effective in controlling relapses and slowing progression across diverse patient profiles.
For those with highly active RRMS who have not responded to first-line therapies, Ocrevus, with its increased dosing frequency, could offer an advantage. However, the distinctions in efficacy between Mavenclad and Ocrevus are generally marginal, making both drugs excellent treatment options for a broad array of patients.
Catering to specific patient needs, Ocrevus seems to be more tailored towards those requiring frequent dosing, while Mavenclad can be more convenient for those who prefer less frequent medication schedules. Consequently, the choice between the two will often hinge on individual treatment goals and lifestyle considerations.For a more in-depth look into these medications and their clinical performance, consult studies available at Ocrevus Efficacy and Induction Treatment Strategy in Multiple Sclerosis.
While both drugs have shown significant promise, the choice of medication should be individualized, considering multiple factors such as side effect profiles, dosing schedules, and the specific needs of the patient. Always consult healthcare providers for the most personalized treatment advice.
Convenience in Administration
Mavenclad's short annual oral dosing schedule may offer convenience, allowing treatment at home. On the other hand, Ocrevus' intravenous administration requires medical visits but is less frequent, which some patients may find preferable.
Both drugs carry an increased risk of infections but via different mechanisms: Mavenclad induces transient lymphopenia while Ocrevus causes sustained B cell depletion. Mavenclad comes with a black box warning for cancer risk, while Ocrevus lacks this warning but may still increase cancer risk.
Indications and Efficacy
Mavenclad is approved for relapsing-remitting MS (RRMS) and active secondary progressive MS (SPMS) in Europe. Ocrevus, on the other hand, is approved for RRMS and primary progressive MS (PPMS) in the U.S. It is the only proven therapy for PPMS, setting it apart as a unique treatment option.
Mavenclad and Ocrevus are potent MS therapies with differing benefits and risks. Factors like lifestyle, family planning, disease severity, and MS subtype may influence which treatment is best suited for an individual patient. Ongoing research will further clarify their long-term safety and comparative effectiveness. Making an informed choice involves weighing these key factors alongside your healthcare provider's guidance.
Comparing Administration and Dosing
The administration and dosing schedules for Mavenclad and Ocrevus present different advantages that could influence treatment choice. Mavenclad is taken orally at home over just two weeks each year. These two annual 4-5 day treatment courses offer the benefit of two years of efficacy. On the other hand, Ocrevus involves intravenous infusion and requires visits to a medical facility every six months, with ongoing infusions to maintain its efficacy.
For those who wish to minimize trips to healthcare settings, Mavenclad's short annual dosing schedule at home sidesteps the need to visit infusion clinics for the hours-long Ocrevus infusions every six months. Conversely, some patients might find Ocrevus' less frequent dosing more convenient. The need for an infusion every six months as opposed to taking oral tablets for two weeks annually may better fit their lifestyle. Those who are not fond of oral medications may also appreciate Ocrevus' intravenous administration.
Mavenclad's limited dosing windows can be advantageous for patients planning for pregnancy, unlike Ocrevus which requires continual dosing. However, it’s important to note that Ocrevus is considered safe during pregnancy based on clinical data, while Mavenclad is contraindicated.
Safety Profile Comparison
The safety profiles of Mavenclad and Ocrevus come with distinct risks and side effects. Both medications carry increased risks of infections but via different mechanisms: Mavenclad results in transient lymphopenia, while Ocrevus causes sustained B cell depletion. Mavenclad carries a black box warning for cancer and is not recommended for those with active malignancies. Although Ocrevus may also elevate cancer risk, it does not carry a black box warning. Mavenclad is contraindicated during pregnancy, whereas Ocrevus is considered safe according to clinical trials.
Common side effects include respiratory infections, headaches, and nausea for Mavenclad, and infusion reactions and oral herpes for Ocrevus. Despite both requiring ongoing safety monitoring, Mavenclad's side effects might be easier to manage, as Ocrevus requires pre-medication before each dose. Conversely, Mavenclad's transient lymphopenia requires vigilance for infections after each short course.
Patient Population Comparison
Mavenclad and Ocrevus are approved for slightly different indications, providing additional considerations for treatment selection. Mavenclad is approved for relapsing-remitting MS (RRMS) and active secondary progressive MS (SPMS) in Europe. It is the only oral option for slowing progression in active SPMS.
Ocrevus, however, is approved for RRMS and primary progressive MS (PPMS) in the US and stands as the only therapy proven for PPMS. For patients with RRMS, both drugs are considered equally effective options. Ocrevus might offer more benefits for those with highly active disease due to its more frequent dosing.
Both Mavenclad and Ocrevus have demonstrated robust efficacy in reducing disease activity in relapsing forms of multiple sclerosis. Clinical trials indicate that Ocrevus slightly outperforms Mavenclad in terms of annualized relapse rate reduction compared to an active comparator—47% for Mavenclad versus 58% for Ocrevus.
Both medications reduced confirmed disability progression by around 40% when compared to placebo or active comparator. Ocrevus led to a higher proportion of relapse-free patients after two years of treatment (89% versus 67% for Mavenclad). Additionally, both drugs significantly reduced MRI lesion activity. Mavenclad lowered active lesions by 80%, while Ocrevus reduced them by 95% when compared to Rebif.
While both drugs have robust effects on key outcomes such as relapse rate, disability progression, and MRI lesions, some experts argue that Ocrevus' higher efficacy in clinical trials may result in better long-term disability prevention. However, real-world data also indicate that both drugs are highly effective in controlling relapses and slowing progression in a wide range of patients.
Stem Cell Therapy as an Alternative Treatment
Mesenchymal stem cell (MSC) therapy offers a promising new treatment option for people with multiple sclerosis, providing an alternative to medications like Mavenclad and Ocrevus. Unlike these cytotoxic drugs, MSC therapy has been shown to reduce inflammation and promote myelin repair, without invasive immunosuppression.
This therapy involves a simple, well-tolerated IV infusion, enabling the stem cells to navigate towards injury sites to exert their anti-inflammatory and neuroregenerative effects. If you're an MS patient contemplating alternatives to your existing treatment plan, MSC therapy could potentially help prevent relapses, reduce new MRI lesions, and improve disability levels. For a comprehensive understanding and to see if MSC therapy is a viable option for you, view our treatment protocol page.
In summary, both Mavenclad and Ocrevus offer highly efficacious treatment options for multiple sclerosis, albeit with different considerations for administration, safety risks, and patient populations. Factors such as lifestyle, family planning, disease severity, and MS subtype can help guide individualized treatment selection. Ongoing research will further clarify their respective roles in MS treatment.
Frequently Asked Questions
Is Mavenclad the same as Ocrevus?
No, Mavenclad and Ocrevus are distinct medications that belong to different drug classes. Mavenclad is a purine antimetabolite, while Ocrevus is a CD20-directed cytolytic antibody. Their differences extend to their mechanisms of action and potentially their side effect profiles. For more information, you can refer to this comparison between Ocrevus and Mavenclad.
Is Lemtrada better than Ocrevus?
There is no definitive evidence to suggest that Lemtrada is better than Ocrevus. Both are considered highly efficacious therapies for multiple sclerosis. Unfortunately, direct comparison trials between the two have not been conducted. For an overview of high-efficacy therapies in MS, including Ocrevus and Lemtrada, you can visit this article.
Is Ocrevus the best MS drug?
Ocrevus is often cited as one of the most effective MS therapies available today. It has exhibited high efficacy in reducing relapses, halting disability progression, and mitigating MRI lesions compared to other standard therapies. However, whether it's the "best" medication for MS is subjective and depends on individual patient factors like disease severity, lifestyle, and tolerability to the drug. For more insights, you can refer to this peer-reviewed source.
What is the success rate of Mavenclad?
In clinical trials, Mavenclad has shown promising results by reducing the annualized relapse rate by approximately 50% when compared to a placebo over a span of two years. Furthermore, 79-80% of patients treated with Mavenclad remained relapse-free at the two-year mark, as opposed to 61% on placebo.
What is the best MS medication for 2023?
Determining the "best" MS medication is complex and depends on various individual factors such as disease activity, safety considerations, and route of administration. Currently, the most effective disease-modifying therapies (DMTs) are generally considered to be Ocrevus, Kesimpta, Mavenclad, Lemtrada, Tysabri, and B-cell therapies like rituximab.
What is the safest MS drug?
Interferon beta drugs, such as Avonex, Rebif, and Plegridy, are likely to have the most favorable long-term safety profiles among MS therapies. However, they are often less efficacious than newer agents like Ocrevus and Mavenclad, which may have more potential risks.
Why is Ocrevus so good?
Ocrevus has shown its effectiveness by selectively depleting CD20+ B cells, which are believed to play a pivotal role in MS-related autoimmunity and nervous system damage. It offers near-complete suppression of new inflammatory activity, as evidenced by MRI and clinical outcomes.
What is the alternative for Mavenclad?
If you're looking for alternatives to Mavenclad, other highly efficacious MS therapies such as Ocrevus, Lemtrada, Tysabri, Kesimpta, and B-cell therapies like rituximab could be considered. Lower efficacy options include Aubagio, Gilenya, and interferon beta drugs. The choice of an alternative largely depends on the specific needs and medical history of the patient.