The edition · Neurology
Ten years of OPERA: a two-year delay in starting ocrelizumab still showed in disability a decade later
Continuous ocrelizumab cut confirmed disability progression by 24% against starting two years later. Also: early plasma p-tau217 results in the memory clinic, ofatumumab versus ocrelizumab in Danish practice, and which minor strokes might do better on dual antiplatelets.
The edition in brief
Ten-year follow-up of the OPERA I and II trials (1,656 patients with relapsing MS) found that patients randomised to ocrelizumab from the start had a lower hazard of 48-week confirmed disability progression than those who took interferon for two years before switching (HR 0.76, 0.61 to 0.95), and of reaching EDSS 6.0 (HR 0.57). Serious adverse events did not rise over the extension. A single-centre Spanish trial in 220 new memory clinic patients found that disclosing plasma p-tau217 and neurofilament light at three months rather than nine raised very high-confidence diagnoses from 4.6% to 50%, increased symptomatic treatment and discharges to primary care, and did not worsen anxiety or mood. In a Danish registry of 1,870 patients, ofatumumab was associated with a slightly higher annual relapse rate than ocrelizumab (0.05 vs 0.03), with no difference in disability worsening. An exploratory ARAMIS subgroup analysis suggested dual antiplatelet therapy might outperform alteplase in very mild stroke due to large artery atherosclerosis, but the interaction was not significant. The pearl covers dual antiplatelet timing after minor stroke and high-risk TIA.
Disclosing plasma p-tau217 early raised diagnostic certainty tenfold without adding distress
In a specialist memory clinic, early disclosure of plasma p-tau217 and neurofilament light sharpened diagnosis and management without raising distress.
Ofatumumab was linked to slightly more relapses than ocrelizumab, but both rates were very low
Ofatumumab and ocrelizumab both gave very low relapse rates; the small difference favouring ocrelizumab is unlikely to matter for most patients.
Very mild stroke from large artery disease may do better on dual antiplatelets than alteplase, in an exploratory analysis
An exploratory ARAMIS subgroup hints that dual antiplatelets may suit very mild stroke from large artery disease; it is not yet a basis for practice.
Dual antiplatelets after minor stroke or high-risk TIA: early and short
After minor stroke or high-risk TIA, start dual antiplatelets early and stop the second drug at about three weeks.
Starting ocrelizumab two years later still showed as more disability at ten years
Starting ocrelizumab early rather than two years later was linked to less disability at ten years; offer high-efficacy therapy early where suitable.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free