Persistence to Ocrelizumab Compared with Other Disease-Modifying Therapies for Multiple Sclerosis: Results from the German NeuroTransData Registry.

Background: Treatment persistence is critical to obtaining full therapeutic benefit and can indicate favorable outcomes. This study examined real-world persistence with ocrelizumab (OCR) versus other disease-modifying therapies (DMTs) and its association with outcomes in relapsing-remitting multiple sclerosis (RRMS) using German NeuroTransData (NTD) registry data.

Methods: This retrospective cohort analysis included outpatients with RRMS who initiated a DMT between January 2014 and April 2022. DMT initiation date was defined as the index date. DMTs were grouped into OCR, injectable, oral, oral for highly active disease (oral HA), and other intravenous (IV) therapies. Persistence, based on having continuous records of a DMT for 2 years from index date, was evaluated within each group. Association between persistence and the risk of relapse, 3-months confirmed disability progression (3mCDP), and sick leave were assessed.

Results: Overall, 3907 patients with RRMS were included. OCR users had the highest persistence at 2 years (93%), then oral HA (78%), oral (67%), natalizumab (67%), and injectable therapies (55%). Compared with OCR users, patients initiating injectable (hazard ratio [HR] 8.51, 95% confidence interval [CI] 4.03-17.90), oral (HR 5.92, 95% CI 2.81-12.50), oral HA (HR 3.49, 95% CI 1.63-7.48) therapies, and natalizumab (HR 5.47, 95% CI 2.47-12.10) were more likely to discontinue. Adverse events (32.47%), lack of efficacy (21.17%), and patient-driven factors (19.73%) were the main reasons for discontinuation. Compared with persisters, non-persisters were associated with higher risks of relapse activity (rate ratio: 2.18, 95% CI 1.98-2.39), 3mCDP (rate ratio 1.52, 95% CI 1.28-1.77), and sick leave (rate ratio 1.71, 95% CI 1.49-1.98).

Conclusions: In a German real-world setting, patients initiating OCR achieved higher rates of persistence over 2 years compared with those on other DMTs. High persistence was associated with lower risk of clinical disease activity, disease progression, and sick leave.