A major trial has found the MS drug ocrelizumab slowed disability progression in primary progressive MS, including older patients and wheelchair users.
The international phase III study, a late-stage clinical trial, included more than 1,000 people across 22 countries.
It tested ocrelizumab against a placebo, an inactive treatment, in people with primary progressive multiple sclerosis (PPMS), a form of MS in which disability steadily worsens over time.
The ORATORIO-HAND study was led by Queen Mary University of London and was described as the largest placebo-controlled treatment trial to date in a broad population of people with PPMS.
Dr Catherine Godbold, senior research communications manager at the MS Society, said: “The results of the ORATORIO-HAND trial are incredibly positive to see.
“MS can be debilitating, exhausting and unpredictable, and hand and arm function is essential for helping people to remain independent.
“Many previous trials have focused solely on walking ability as a measure of whether a drug is effective.
“But trials like this are vital in helping us find treatments for everyone.
“Ocrelizumab is already used as a treatment for active relapsing MS and early primary progressive MS.
“These results could mean it is made available for more people with primary progressive MS, who don’t currently have access to any treatment options.
“The key now is how we work together to see these findings translated into clinical practice.”
Overall, people treated with ocrelizumab had a 30 per cent lower risk of disability progression than those who received placebo.
The treatment also reduced worsening of hand and upper-limb function by 41 per cent at 12 weeks.
Among people who were unable to walk or move around freely at the start of the study, ocrelizumab reduced the risk of requiring a wheelchair by 52 per cent.
Researchers said the effect appeared greater in people who showed signs of inflammatory disease activity on MRI scans, which use magnets and radio waves to create images inside the body, at the start of the trial.
In this group, the treatment was linked to a 55 per cent reduction in the risk of disability progression.
PPMS affects between 10 and 15 per cent of people with MS. Unlike relapsing forms of MS, treatment options remain limited, particularly for people with more advanced disease.
Previous major studies often excluded people aged 55 and above or those with advanced disability. By contrast, this trial included people aged up to 65 and many with substantial mobility impairment and advanced disease progression.
In the study, researchers focused on walking ability and also assessed upper-limb function using the 9-Hole Peg Test, a test that measures hand and arm dexterity.
They said this was important because preserving hand function can help people with advanced PPMS maintain independence, communication and quality of life.
In a separate survey conducted by professor Gavin Giovannoni and colleagues at Queen Mary, people with worsening MS prioritised upper-limb and hand function over lower-limb function, citing independence, grooming and toileting.
Researchers said the findings suggest ocrelizumab could benefit a wider group of people than currently have access to it, potentially influencing how MS is managed on the NHS and how future progressive MS trials are designed.
Lead author professor Gavin Giovannoni, professor of neurology at Queen Mary, said: “These findings are important because they show that treatment can make a meaningful difference to people with more advanced forms of MS and can help preserve hand and arm function, which is important for maintaining independence, daily activities and quality of life.
“Our study suggests we should think differently about what successful treatment looks like in advanced MS and that we shouldn’t assume a lack of benefit in certain groups.
“The O’HAND study changes the way we manage and think about MS.”
