What Are Mayzent and Ocrevus?

Mayzent (siponimod) and Ocrevus (ocrelizumab) represent two different approaches to treating multiple sclerosis. Mayzent, developed by Novartis, is an oral medication classified as a sphingosine 1-phosphate receptor modulator. It works by preventing lymphocytes (white blood cells) from leaving lymph nodes, reducing the number of these cells that can reach and damage the central nervous system.

Ocrevus, developed by Genentech (a member of the Roche Group), is an intravenous infusion therapy that targets a specific type of immune cell called CD20-positive B cells. These cells are believed to contribute to the immune system attacks on myelin, the protective coating around nerve fibers. By reducing these B cells, Ocrevus aims to decrease inflammation and subsequent nerve damage in MS patients.

Treatment Administration and Frequency

One of the most notable differences between these medications is how they're administered. Mayzent is taken orally once daily, which many patients find convenient for their lifestyle. The treatment begins with a titration period where the dose gradually increases over several days to reduce potential side effects, particularly those affecting heart rate.

Ocrevus follows a different schedule entirely. It's administered as an intravenous infusion in a healthcare setting, typically every six months. Each treatment consists of two separate infusions given two weeks apart for the first dose, then a single infusion every six months thereafter. While this means fewer treatment days overall compared to daily medications, each infusion session takes several hours, and patients must arrange for transportation and recovery time.

Effectiveness for Different MS Types

Both medications have shown effectiveness in clinical trials, but their approved uses and effectiveness vary for different types of MS. Mayzent is primarily approved for relapsing forms of MS, including secondary progressive MS (SPMS) with active disease and clinically isolated syndrome. In clinical trials, Mayzent reduced the risk of disability progression by 21% compared to placebo and decreased the annualized relapse rate by 55%.

Ocrevus stands out for being approved for both relapsing forms of MS and primary progressive MS (PPMS). This makes it one of the few treatments available for PPMS patients. In clinical studies, Ocrevus reduced relapse rates by 46-47% compared to interferon beta-1a in relapsing MS patients. For PPMS patients, it showed a 24% reduction in the risk of disability progression compared to placebo. The broader approval for multiple MS types makes Ocrevus an option for patients who previously had limited treatment choices.

Side Effects and Monitoring Requirements

Safety considerations play a crucial role in medication selection. Mayzent requires several pre-treatment assessments, including blood tests, an electrocardiogram, and eye examination. This is because it may affect heart rate, liver function, and vision. Common side effects include headache, high blood pressure, and elevated liver enzymes. Patients with certain heart conditions may not be eligible for this treatment due to potential cardiac effects.

For Ocrevus, infusion-related reactions represent the most common side effect, occurring in approximately 34-40% of patients, though most are mild to moderate. Other potential side effects include upper respiratory tract infections and an increased risk of herpes infections. Both medications can increase susceptibility to infections due to their effects on the immune system, and both require monitoring for progressive multifocal leukoencephalopathy (PML), a rare but serious brain infection.

Mayzent requires more frequent monitoring initially but transitions to routine checks, while Ocrevus patients typically undergo assessments before each six-month infusion.

Insurance Coverage and Cost Considerations

The financial aspect of MS treatment cannot be overlooked. Both Mayzent and Ocrevus are specialty medications with significant costs. Without insurance, annual treatment costs can exceed $80,000. However, both manufacturers offer patient assistance programs to help eligible patients access treatment.

Insurance coverage varies significantly between plans. Some insurance providers may prefer one medication over the other based on negotiated contracts. Additionally, the different administration methods affect how these treatments are categorized by insurance: Mayzent typically falls under pharmacy benefits, while Ocrevus is usually covered under medical benefits, which can impact out-of-pocket costs.

Patients should work closely with their healthcare providers, insurance companies, and potentially patient advocacy organizations to understand coverage options. Many neurology practices have dedicated staff to help navigate these complex financial considerations and connect patients with assistance programs from Novartis or Genentech.

Conclusion

The choice between Mayzent and Ocrevus depends on multiple factors including MS type, lifestyle preferences, comorbidities, and insurance coverage. Patients with relapsing forms of MS might prefer the convenience of Mayzent's daily oral dosing, while those with primary progressive MS or those who prefer less frequent treatment might lean toward Ocrevus. Neither medication represents a universal solution for all MS patients, highlighting the importance of personalized treatment plans.

Working closely with a neurologist specialized in MS is crucial to weigh these considerations properly. As MS treatment continues to advance, these medications represent important options in the expanding toolkit available to manage this complex neurological condition. The decision should ultimately prioritize effectiveness for the individual's specific MS presentation while accounting for quality of life and long-term treatment sustainability.

Citations

This content was written by AI and reviewed by a human for quality and compliance.