Ten years of OPERA: a two-year delay in high-efficacy MS treatment was not made up

The edition in brief

Today's neurology edition closes on the ten-year results of OPERA I and II. Patients with relapsing MS randomised to ocrelizumab from the start, rather than interferon beta-1a for two years before switching, had a 24% lower hazard of 48-week confirmed disability progression (HR 0.76, 0.61 to 0.95) and a 43% lower hazard of reaching EDSS 6.0 (HR 0.57, 0.40 to 0.82); safety signals did not rise over the open-label extension. A meta-analysis of 12 randomised trials with more than 2,300 patients found minimally invasive evacuation of supratentorial intracerebral haemorrhage was associated with lower all-cause mortality (RR 0.77) but no clear gain in good functional outcome, and with more rebleeding and cardiac events. A post hoc analysis of ESCAPE-MeVO found perfusion mismatch volume and ratio neither predicted outcome nor identified patients who benefited from thrombectomy for medium vessel occlusion. In 1,870 Danish patients with relapsing-remitting MS, ofatumumab was associated with a slightly higher annualised relapse rate than ocrelizumab (0.05 vs 0.03), with no difference in disability worsening. The pearl is on catching degenerative cervical myelopathy early.