People with relapsing-remitting MS can only be treated with ocrelizumab if alemtuzumab is contraindicated or otherwise unsuitable. The latter is a very grey area and will be open to interpretation. My question is how does patient choice taken into account? NICE clearly does not think this is a priority; for NICE cost-effectiveness trumps patient safety and choice.
This appraisal does not refer to the primary progressive indication. If you think ocrelizumab has had a hard time in RRMS it is going to have an even harder time in PPMS.
ProfG
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If someone is on Natalizumab and wants to switch for no reason other than convenience, would this be possible in light of this appraisal? My Neurologist told me I would be able to but that was 2 years ago when diagnosed.
Only if alemtuzumab is unsuitable.
My reinterpretation of the NICE guidance is that if patients are not keen on immunosuppression and the risk of secondary autoimmunity and/or autoimmunity then they could choose ocrelizumab. The question is will blueteq accept this as a valid reason?
Does the patients opinion count towards making the decision of suitably? I too, like the poster of the original question, opted for Tysabri given the risks were far greater with lemtrada, given I was JC-.I don’t wish to stay on a medication which long term has rebound effect, and I could change to JC+ at anytime.
when is lemtrada unsuitable?
RE: "when is lemtrada unsuitable?"That is the question. I assume when somebody with MS is not keen to take the risks of a second autoimmune disease or the hassle of the monitoring requirements.
Can you take ocrelizumab if you failed on 2 courses of alemtuzumab?
Good question because another question would be if you have failed on two alemtuzumab we should be allowed to have a third dose which nice have also declined. Which would be cheaper and which would be better for the patient?
Yes. A third dose would be better but I'm thinking more about preventing 2nd autoimmunity. Which will make alemtuzumab safest treatment and the most effective.
Blimey – one step forwards, one step back for pwMS. It is rather grey.However, for me I am somewhat astounded that there is no one on the evaluating group (Committee B members as per the link in the article above) are neurologists/clinicians with hands on expertise of pwMS. Is this normal, getting bean counters and non-experts to evaluate new meds? Maybe I'm missing something here. Is anyone able to explain the composition of the evaluating group and how they are put together? Clearly academics with experience in assessing economic angles get seats, but the others? I don't mean to be dismissive of the individuals named and their expertise, but I had expected to see a range of people with demonstrable experience of MS patients and the other treatments mentioned.
Can either prof G or KS comment on whether they think a third alemtuzumab is preferable to ocrelizumab please