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Ocrelizumab Reduces Progression of Upper Extremity Impairment in Primary Progressive MS

Laura Joszt
For patients with multiple sclerosis (MS), upper extremity (UE) impairment is not uncommon, and patients with primary progressive MS tend to have a higher prevalence of UE dysfunction and greater impairment.
For patients with multiple sclerosis (MS), upper extremity (UE) impairment is not uncommon. Although patients across MS types report impaired UE function, patients with primary progressive MS (PPMS) tend to have a higher prevalence of UE dysfunction and greater impairment.

A new study compared ocrelizumab with placebo in patients with PPMS to examine the effects of the therapy on confirmed progression and confirmed improvement in UE impairment. The results were published in the Multiple Sclerosis Journal.

UE impairment can affect patients’ independence and quality of life, and UE dysfunction can also be associated with unemployment. “Therefore, objective quantitative assessment of UE functionality is critical for monitoring overall MS disease progression and evaluating the benefit of MS therapy,” the authors explained.

The researchers used the Nine-Hole Peg Test (9HPT), a component of the Multiple Sclerosis Functional Composite, to understand UE function. The 9PHT was administered at baseline and every 12 weeks until the end of the study and researchers tested both hands twice to determine the time it took to complete the test.

Patients were randomized 2:1 to receive either ocrelizumab 600 mg (administered as two 300-mg intravenous infusions given 14 days apart) or placebo every 24 weeks for at least 120 weeks. The analysis included an intention-to-treat population and subgroups stratified by their baseline 9HPT time.

Among the intention-to-treat population, ocrelizumab significantly reduced the risk of 12- and 24-week confirmed progression of ≥20% on the 9HPT versus placebo in both hands. During the baseline test, one hand was identified as the better hand and the other as the worse hand, and there were reductions with ocrelizumab for both, although the effects were less pronounced in the worse hand.

“In a chronic disease like PPMS that is typically diagnosed during the most productive years of a patient’s life span, preservation of UE function is an important therapeutic goal,” the authors wrote. They added, “Findings from this analysis showed that ocrelizumab mitigated progression of UE impairment in patients with PPMS using the 9HPT.”


Fox EJ, Markowitz C, Applebee A, et al. Ocrelizumab reduces progression of upper extremity impairment in patients with primary progressive multiple sclerosis: findings from the phase III randomized ORATORIO trial. Mult Scler J. 2018;24(14):1862-1870. doi: 10.1177/1352458518808189.

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