Briumvi for Multiple Sclerosis Explained by Neurologist

00:25 Overview
5:05 Pharmacology
7:02 Clinical Trial Results
15:14 Side Effects
20:26 Laboratory Testing
22:01 Miscellaneous
Briumvi is a new b-cell depleting drug for multiple sclerosis similar to medications such as Ocrevus, rituximab, and kesimpta. In this video, I review how Briumvi works, the results of clinical trials, the pharmacology, side effects, laboratory monitoring, and special considerations such as pregnancy and breast feeding.
Selected Sources:
Clinical trial results: pubmed.ncbi.nlm.nih.gov/36001...
Briumvi Product Label: www.accessdata.fda.gov/drugsa...
Summary of data from Ultimate I and II trials: practicalneurology.com/news/u...
Ublyxi: Highly Effective Drug for Multiple Sclerosis: biopharma.media/ublituximab-h...
Glycoengineered antibodies: towards the next-generation of immunotherapeutics: pubmed.ncbi.nlm.nih.gov/30289...
Comment or ask questions below! I would be happy to answer!
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Check out my book “Resilience in the Face of Multiple Sclerosis” FREE on Amazon: amazon.com/dp/B07WP7H5LK It's about 5 people with MS who live incredible lives, the science and psychology of resilience, mindfulness, and ho’oponopono. Paperback priced to generate $0 royalty.
Dr. Brandon Beaber is a board-certified neurologist with subspecialty training in multiple sclerosis and other immunological diseases of the nervous system. He is a partner in the Southern California Permanente Medical Group and practices in Downey, California (South Los Angeles). He has several publications on MS epidemiology and has participated in clinical trials for MS therapeutics. You can follow him on twitter @Brandon_Beaber where he regularly posts about MS news and research.
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Music: INNER GRACE - Copyright 2018 Wilton Vought Source: Really Really Free Music Link: • Video T
he video material by Dr. Brandon Beaber is general educational material on health conditions and is not intended to be used by viewers to diagnose or treat any individual's medical condition. Specifically, this material is not a substitute for individualized diagnostic and treatment advice by a qualified medical/health practitioner, licensed in your jurisdiction, who has access to the relevant information available from diagnostic testing, medical interviews, and a physical examination. To the extent that Dr. Beaber endorses any lifestyle change, behavioral intervention, or supplements, the viewer should consult with a qualified healthcare professional to determine the safety and efficacy of the intervention in light of their individualized information.

[@peterwilliams6361]

I'm diagnose with cancer, i have just 2 years to live, i've never been this scared to die, i'm just 35, i cry everyday wishing for a miracle to happen. i don't know why im saying this here. put me in your prayers.

[@peterwilliams6361]

@Chris Young That's wonderful, how do i get in touch with the healer?

[@peterwilliams6361]

@Chris Young Thank you very much. i just checked and i found her. i'm excited.

[@annmariemoreno3904]

God bless you always in my prayers 🙏🙏🙏

[@Jerusalem_Warrior]

Don't despair. The Bible states: "And the doctor will cure" (Exodus 21:19), literally meaning that someone who harms another is liable for the medical expenses, but interpreted to mean that the doctor has the right to heal, NOT the right to plunge people into despair: How does HE know that you have 2 years to live? What right does he have to depress you, just to cover his own a**? A lot more than your cancer is going to determine the length and quality of the rest of your life. Attitude and faith is going to make a difference. Best blessings to you from Jerusalem. 🙌

[@whoosh_angel]

I am praying for you Peter. I am 34 and I thought I was going to die recently. During that time, the Lord showed me this verse 3 times: “Alas! For that day is great, So that none is like it; And it is the time of Jacob’s trouble, But he shall be saved out of it.” ‭‭Jeremiah‬ ‭30‬:‭7‬ ‭NKJV‬‬ Here is a different translation: “In all history there has never been such a time of terror. It will be a time of trouble for my people Israel. Yet in the end they will be saved!” ‭‭Jeremiah‬ ‭30‬:‭7‬ ‭NLT‬‬ And I can’t say what God’s plan is for your life, but I can say that He is with you always, even now, closer to you than your own breath. 🤍 If you have a Bible, please read through the Psalms. I will be praying.

[@nafre4626]

I started on Briumvi a few months ago. I have to say that it is working much better for me than O or K did. I hope everyone finds the best drug for them.

[@DrBrandonBeaber]

I'm glad you are doing well.

[@melr8720]

I was diagnosed 2 weeks ago and got my first dose of Briumvi yesterday, can you elaborate on why it’s working better than O?

[@DrBrandonBeaber]

@@melr8720 I wouldn't be able to give an explanation for this. I have no reason to think Briumvi overall.

[@_Patton_Was_Right]

Most patients are responding better to Briumvi, and patient switches from Ocrevus are accellerating!

[@300M3R]

Diagnosed 8/23/23. Doctor recommended Briumvi and I'm going that route. Waiting for blood work and insurance. Low signs of disability which I'm so thankful for. Absolutely terrified.

[@DrBrandonBeaber]

Good luck to you.

[@DoctorGretchenHawley]

Thank you for the update! Your videos are always so helpful.

[@mywaterbaby1]

Amazing, outstanding you are on top of my list. You are amazing doctor.

[@AaronBosterMD]

Excellent video!

[@EvenSoItIsWell]

Thanks Dr. Beaber! I appreciate your videos on the medications. I find them very helpful.

[@DrBrandonBeaber]

Thanks

[@desiredecove5815]

Not heard of this before- thank you for explaining everything. As usual, you did a great job. Have an awesome day.#Sharingiscaring

[@DrBrandonBeaber]

Thanks Desire!

[@mattz5275]

Outstanding video! Hope you're well

[@DrBrandonBeaber]

thanks

[@Robin-me8fe]

very interesting ! Thx

[@keeferification]

I wish someone would do a three way comparison study: Ocrevus vs. Kesimpta vs. Briumvi. I understand they're trying to market their product in a good light ("oh, our drug is better than far less efficacious drug X"). We didn't exactly need a study to deduce that a B cell killer will mop the floor with Aubagio. Sheeeeesh.

[@DrBrandonBeaber]

I do have a video on Ocrevus vs. Kesimpta: kzbin.info/www/bejne/eIfLf2eVqKqcZ9U

[@keeferification]

@@DrBrandonBeaber Indeed, and I've watched it. I mean a legit white paper that looks into other things, such as waning efficacy at say... 75%-90% through the dosing cycle. I've been on both Ocrevus and now Kesimpta, and I can say with both, I notice a discernible difference at the beginning of the dose cycle, versus the tail end. Additionally, excuse me if I'm using terminology incorrectly. I am just a layman with MS.

[@inreallife21]

That will never happen, but it would be nice to have all the therapies compared head to head

[@freethinkeralways]

​@@inreallife21 Pharma will not do it, but may b someone in translational research could analyze published data head to head?

[@inreallife21]

@@freethinkeralways I think it may be like comparing apples to oranges since each study is conducted differently with different inclusion/exclusion criteria and end points.

[@donnabolt5847]

This was great! I really understood the information you presented- I really hope you go into teaching one day! This is such a gift you have plus you are empathetic. It's nice to know there are more options for us. Future video: brain loss volume Oh... have you heard anything on tysabri being taken as an injection in the US?

[@DrBrandonBeaber]

We actually do have some medical students, so I am [minimally] involved in teaching. Thanks for the video suggestions. I don't yet have a video on subcutaneous tysabri.

[@luciece]

Thanks for this video! How do you personally explain low neutrophils while on anti-CD20s (it's not their target)? I know there has been rare cases of neutropenia with Rituximab/Ocrelizumab as well. Also, does risk of cancer increase with long term administration of anti-CD 20 (similar to infection risk)? Vid recommendation: SC vs IV administration of anti-CD20s

[@roberture5903]

Good morning Dr Brandon, this is the first that I've heard of this medication and thank you for the informative video. For my money though I will probably stick with tysabri but the only thing that worries me about that is the risk of PML and I know the longer you've been on it there is more of a risk. The good thing for me is even after three years on the medication I'm still JC virus negative and no new lesions thus far. Thank you again for keeping us up to speed have a great day sir

[@DrBrandonBeaber]

Luckily, the risk of PML with Tysabri remains low if JC virus antibody is negative, regardless of the length of use, but talk to your own provider.

[@roberture5903]

@@DrBrandonBeaber thank you for the quick reply sir oh, also I feel bad that I didn't comment on last weeks interview you had with dr. Burke. Just wanted you to know I thoroughly enjoyed it and he seems to really seems to be a very down-to-earth person and he knows his his stuff also. It would really be nice if the stem cell treatment became more mainstream here in the United States one day.

[@roberture5903]

I'd like to take this time if I could all four people for liking my comments. It means a lot and I try to religiously catch dr. Brandon Bieber every week because he seems like a phenomenal neurologist and wonderful person.

[@hurkuy]

As an MS patient from Australia, I have been watching your videos every week, very informative, I learned a lot from you about my disease. Are you planning to make a video about the new MS drug called Evobrunitib? Would love to hear your thoughts as it looks very promising. I joined the phase 3 trial 3 months ago, (comparison of Aubagio and Evobrunitib), it’s double blinded but I strongly think I’m on Evobrunitib because I didn’t have any side effects of Aubagio. I had every single side effects of Evobrunitib. Hope you ll make a video and share your thoughts on Evobrunitib❤

[@Jerusalem_Warrior]

✔ ✔ 👍🏻 Sounds correct. 👌

[@brookelong4748]

Haven’t taken this drug, but I take Ocrevus. Just had my first MRI post diagnosis and treatment. I have a significant amount of improvement with no new spots. I can’t see wanting to choose this over O - but I hope this makes availability better for everybody with more competition of B cell depletion therapies!

[@ldjt6184]

What kind of improvements with O?

[@brookelong4748]

@@ldjt6184 some of my spots are healing

[@ldjt6184]

@@brookelong4748 Wow! Pretty cool :)

[@SpiritualSchmuck]

The Ocrevus can cause breast cancer in some women. Though i am not a woman that sketches me out.

[@melr8720]

@@SpiritualSchmuck is it the same for Briumvi ?

[@ernietollar7767]

Briumvi stats specific to PPMS are not notable beyond Ocrevus or Rituxan ? Ok. A few weeks after my 2nd Ocrevus 1/2 infusion for PPMS now, at age 58. having had MS for at least a few years, I feel Balance and numbness / stiffness has worsened slightly (but clearly) faster than ever before since starting on Ocrevus just 3 1/2 weeks ago since the date of my first half infusion on Jan 12, 2023. I'm not even talking about infusion reactions (which were fairly minimal) - but specifically my gait, balance and stiffness . B Cell depletors may only have negatives and no positives for MY PPMS - or so I am led to wonder. My sense is that I may as well at least get my joie de vivre and fabulous immune system back and get of DMT's and free up my good neurologist for work with others with RRMS or some MS that responds favorably to the current arsenal. Why has my progression sped up on Ocrevus? My PPMS was only ever characterized by v e r y s l o w progression prior to Ocrevus. Is it possible that my body was doing all it could, in spite of the PPMS, to hang on and try to keep up Myelin condition as best it could and that since being recieving Ocrevus the battle is being lost a tad more quickly. I have lived for a few years at least with only a very slow imperceptible rate of progression, but now on B-cell depletion drug the disease is progressing perceptibly. My EDSS is low still and I adapt well I to re-learning things (with my plastic human brain). i don't need a sand bag around my ankles if it has no positiv benifit.

[@dermlover1]

In your experience, does using these drugs for CIS actually slow down time to MS or even prevent full blown MS? Are you regularly treating CIS with drugs?

[@brentburleigh1524]

Good info

[@DrBrandonBeaber]

Thanks

[@whoosh_angel]

Can you do a video comparing briumvi and Kesimpta?

[@MPharma-]

Dear Dr. Brandon Beaber could you please review Briumvi now after more then a year on the market? Thanks.

[@DrBrandonBeaber]

I don't think I would give any major updates to this video to be honest.

[@tpt2834]

It appears that Ocrevus is a really good drug however, it had 6 cases of breast cancer out of 781 people in the trial prompting the FDA to put a cancer warning on the label. I am trying to consider what is the better drug vs Briumvi which did not have any breast cancer and the Briumvi label has NO cancer warning. In trying to make a decision as to which drug is better or safer it seems to me that NO cancer elevation is a huge benefit of Briumvi. Am I missing something here? Please advise and if you could elaborate It would be a great decider for me. Thanks for your excellent work.

[@Zephas99]

For those of us with re-activated EBV would it not be a good idea to get that under remission first?

[@KelliMaysAboagye]

Dr. Beaber...can you do the same video but comparing ocrevus and kesimpta vs. briumvi?

[@Sup-jz2ow]

Are there any studies on briumvi and brain atrophy?

[@carolineartley1243]

The graph that showed b cell depletion showed it took 96 weeks for b cells to start increasing. Was that after 1 dose? Or after 96 weeks of regular infusions (presumably 3 full doses) do b cells start to climb again?

[@kevinmarchetti8454]

Dr. Beaber - Have you come across references on Arava vs. Terofluomide? Or have heard of anyones anecdotal experience on this topic? Asking in a general manner, not related to any specific patient.

[@DrBrandonBeaber]

I have a video on this exact topic you may appreciate: kzbin.info/www/bejne/pqOyhZebfppjgrM Aubagio and Arava are essentially the same drug.

[@thomashilbert7319]

Would this drug make sense for patients switching off either Ocrevus or Kesimpta? I also read something about Briumvi being the lowest priced therapeutic approved for Multiple Sclerosis, would you expect Briumvi to also require the lowest out of pocket cost for patients (on average)?

[@DrBrandonBeaber]

Out of pocket costs are variable depending on location/insurance, but certainly many medications are much cheaper (rituximab, arava azathioprine, dimethyl fumarate).

[@brianguppy7693]

I was dx'd in March of this year (2023) and had my first two Briumvi infusions in early and mid May. Things felt pretty agitated / flared up and I felt pretty wiped out until about early June. I guess this makes me one of the 5% who experience the "fatigue" side effect, though this is so vaguely worded that it's hard to be sure. I had no reaction at all to either infusion, and now that I've recovered from the fatigue, the improving trend I was on prior to getting treatment has resumed. My neuro says that I most likely will have milder side effects with subsequent infusions, so as long as that turns out to be the case I will continue on this drug until I start having to worry about low IG levels.

[@DrBrandonBeaber]

Best of luck to you Brian.

[@danielmcinerney9949]

How has the DMT drug worked out for you? Thanks so much

[@brianguppy7693]

Just had my 3rd infusion a week ago Monday. Felt the effects of the steroids for a couple of days but otherwise fine. No fatigue like last time.

[@danielmcinerney9949]

@@brianguppy7693 thanks so much I’m terrified to start because of potential side effects I wish I could get over it because I’m declining fast….

[@brianguppy]

@@danielmcinerney9949 I'd be a lot more afraid of MS than of B cell depleters. If your neuro is offering you a high efficacy DMT then jump on it asap.

[@PewPewGuy85]

I was on Gilenya before I stopped using it. I paid nothing and didn’t have any thing happening to make me feel like it was helping. But now they want to put me Briumvi and it cost a lot with insurance. I haven’t started treatment yet but afraid it will make me go broke to keep from getting too much worse

[@shkodra1505]

great video doc , i wanted to ask , how effective are dmts at achiving long term NEDA in RRMS , i have been diagnosed with ms 6 years ago when i was 16 and i was in remission for 6 years until now. as i am looking into HSCT and other medication i just wanted to ask what are the chances of long term NEDA with newer dmts (i am not asking for advice just stats as i am unable to find them)

[@DrBrandonBeaber]

You can take a look at table 3 in this article: jamanetwork.com/journals/jamaneurology/fullarticle/2048956 NEDA was 47% in the AFFIRM study with tysabri and 39% in the CARE-MSI study with Lemtrada, but often, the numbers aren't great. Keep in mind, someone with improvement of disability, no relapses, but a single tiny new lesion on a single MRI would not meet the criteria for NEDA. Generally, speaking HSCT with BEAM has pretty good data in terms of NEDA, though obviously there are significant risks.

[@shkodra1505]

@@DrBrandonBeaber thx doc , if i may one more question. Again not asking advice ,just stats. Are long term remissions and relatively mild symptoms indicators of a mild disease prognosis or these may be illusions as mild symptoms may seem mild to young individuals?

[@KimsaLittleofAlot]

I was on Tysabri for 11 years. I have to take briumvi starting next month. My jcv tieter was at 5.77 my doc never saw numbers that high

[@DrBrandonBeaber]

That is quite high

[@klinexXEst1997]

Doctor do dmt drugs other than fewer relapses have an effect on the progression of disability on the edss scale?many official studies show that they do not have much effect. Furthermore I have seen some studies official too talking about the mitochondria and the deletion of them in people with multiple sclerosis through life and a link of that in Epstein Barr

[@klinexXEst1997]

Why always have the same approach on Ms medication if we not even known the causes ...as I study and learn more I feel more sad of this disease

[@DrBrandonBeaber]

@@klinexXEst1997 There is an anti EBV drug called ATA-188. More info in this video: kzbin.info/www/bejne/Z6bJq4B8oZ2sodk

[@Jerusalem_Warrior]

2 months after my Ocravus infusion, I broke out in herpes zoster! It was awful. Could being immunosupressed have done that? What blood values should I be checking for? 🙄

[@annmariemoreno3904]

I'm supposed to start mavenclad I have secondary MS is this drug good or is new drug better?

[@DrBrandonBeaber]

I can't give you personal advice here. Neither mavenclad nor briumvi have specific clinical trials in secondary progressive MS to my knowledge.

[@SpiritualSchmuck]

I would talk to people in the Ms community that have used Brumavi and see what they say. I've heard great things.

[@melr8720]

Just had my first infusion yesterday, my heart rate went up a little but that could have been the steroids. No adverse reactions, but I was hoping some of the fog would be gone.

[@DrBrandonBeaber]

Thanks for sharing.

[@Paul9735]

Would you say this has a higher or lower concentration of monoclonal antibodies compared to Ocrevus?

[@SpiritualSchmuck]

I'm not sure why there isn't a big deal made about Ocrevus causes breast cancer in some women.

[@freethinkeralways]

Thank you, Dr. Beaber, for using absolute values! The side effects of Briumvi seem to outweigh its benefits... Is it possible to use it for a cute attacks in RRMS instead of IV Solumedrol?

[@DrBrandonBeaber]

This is a disease modifying therapy which would not be used for acute relapses.

[@freethinkeralways]

@@DrBrandonBeaber Thank you!

[@danielmcinerney9949]

All of them seem scary 🤷‍♂️ I’m terrified

[@ank1288]

How did you calculate the NEDA 198% improvement at 14.41? and 277% improvement ?

[@DrBrandonBeaber]

198% and 277% improvement COMPARED to teriflunomide (Aubagio). For instance ((43/11.4)-1)x100 = ~277. Of course, the study authors calculated this, not me. But it appears to be correct.

[@ank1288]

@@DrBrandonBeaber thanks your videos are so helpful , I also saw on their website that briumvi had no relapses - 86% were relapse free compared to aubagio in study 1 and in study 2 87% had 0 relapses compared to 72% on aubagio but I couldn't see this mentioned in the actual clinical trial study - any idea where this has come from ?

[@DrBrandonBeaber]

@@ank1288 There are all kinds of secondary analyses that do not make it into the main publication.

[@paulahall1700]

Have you done a similar UTube on Rutuimab?

[@DrBrandonBeaber]

Yes. Here you go: kzbin.info/www/bejne/eF7baYCuj8l6fa8

[@MSman77]

👍

[@MrMikk532]

My neurologist and I discussed this medication. I decided I didn't want to use such a new medication and went for ocrevus

[@SpiritualSchmuck]

Ocrevus sometimes causes breast cancer in women. Which is a huge negative. Also Roche has a big lawsuit they can't get thrown out for another drug with horrible side effects.

[@AmandaSmien]

briumvi does not have the breast cancer side effect. ocrevus is only 4 years earlier to market. both drugs have been studied for nearly the same amount of time. i hope you are doing well. don't be afraid of briumvi they work similar chemically but briumvi is less injection time

[@MrMikk532]

@@AmandaSmien Still, as someone who is incredibly risk adverse and adverse to unknown consequences, ocrevus to me was more comforting. At the time that I was offered MS medication, it had only been FDA approved less than a month. My neurologist was also kind of iffy/unconvinced on the real world risk of breast cancer with ocrevus was. Can't remember the specifics about this conversation. They may work similarly as both are CD20 monoclonal antibodies, but they're not 100% the same. Made the decision to go with the tried and true and will probably stay that way until something proves that it's worth the switch. More research on ocrevus+pregnancy which matters to me as I plan on getting pregnant in the upcoming years (ignore username, am female)

[@Sbannmarie298]

Listen to last 3 minutes of video and you’ll get his recommendation. Spoiler alert- he doesn’t recommend it.