From the FDA Drug Label
OCREVUS ZUNOVO is indicated for the treatment of: ... Primary progressive MS, in adults The recommended dosage of OCREVUS ZUNOVO is 920 mg/23,000 units (920 mg ocrelizumab and 23,000 units of hyaluronidase) administered as a single 23 mL subcutaneous injection in the abdomen over approximately 10 minutes every 6 months.
Treatment for Primary Progressive MS: Ocrelizumab (IV) is indicated for the treatment of primary progressive MS in adults. The recommended dosage is 920 mg/23,000 units administered subcutaneously every 6 months 1.
From the Research
Primary Progressive Multiple Sclerosis (PPMS) treatment should involve ocrelizumab (Ocrevus) as the first-line therapy, given its proven efficacy in reducing disability progression and its FDA approval specifically for PPMS. Ocrevus is administered as an intravenous infusion every six months, with the initial dose split into two infusions given two weeks apart 2. The treatment of PPMS also includes symptom management with medications for specific issues like fatigue (modafinil, amantadine), muscle spasticity (baclofen, tizanidine), pain (gabapentin, pregabalin), and bladder dysfunction (oxybutynin) 3, 4, 5.
Key Considerations in PPMS Treatment
- Physical therapy, occupational therapy, and speech therapy are crucial components of PPMS management to maintain function and independence.
- A comprehensive approach is necessary because PPMS differs from relapsing forms of MS by showing steady progression without distinct relapses and remissions, making it more challenging to treat.
- The goal of treatment is to slow disability progression and manage symptoms to maintain quality of life, as there is currently no cure for PPMS.
Emerging Therapies and Future Directions
- Other medications sometimes used include rituximab (off-label), siponimod (Mayzent), and cladribine (Mavenclad), though these aren't specifically approved for PPMS 3, 6.
- Research into new therapeutic strategies, including cell metabolism modulation and inflammatory pathways inhibition, is ongoing, with the aim of reversing disability and arresting disease progression 4, 5.
Evidence Base
The recommendation for ocrelizumab as the first-line treatment for PPMS is based on the most recent and highest quality evidence available, including a review of its efficacy in reducing disability progression and its approval by regulatory authorities 2. While other studies and reviews provide additional context and insights into the management of PPMS, the primary consideration in treatment decisions should be the evidence from the most recent and rigorous clinical trials.