Indications
Ocrelizumab is used to treat adults with multiple sclerosis (MS), a long-term disease in which the immune system attacks the protective covering of nerves in the brain and spinal cord. It is used for relapsing forms of MS (with attacks followed by recovery) and for early primary progressive MS (which worsens steadily from the start). It reduces relapses and slows the build-up of disability.
How It Works
Ocrelizumab is a monoclonal antibody, a laboratory-made protein that targets a marker called CD20 found on certain white blood cells (B cells). These B cells are thought to play a key part in the nerve damage of MS. Ocrelizumab removes them from the blood, which calms the abnormal immune activity. The B cells slowly return after treatment is stopped.
Dosage and Administration
It is given in hospital or a specialist clinic by a doctor or nurse, as an infusion into a vein (a form for injection under the skin is also available in some countries). The first dose is usually split into two infusions two weeks apart, followed by one dose every six months, as prescribed by the neurologist. Before each infusion, medicines such as a steroid and an antihistamine are given to reduce infusion reactions, and the patient is watched during and after the infusion.
Interactions
- Live or live-attenuated vaccines should not be given during treatment and until B cells recover; other vaccines should ideally be completed at least 6 weeks before starting.
- Other medicines that suppress the immune system (including some other MS treatments and cancer medicines) increase the risk of infections.
- Blood pressure medicines may add to the drop in blood pressure that can occur during infusion.
Contraindications
- Active hepatitis B infection.
- Active serious infection or a severely weakened immune system.
- Known active cancer.
- Allergy to Ocrelizumab.
Side Effects
The most common side effects are infusion reactions (itching, rash, flushing, throat irritation, headache, fever, nausea or fast heartbeat during or soon after the infusion) and infections such as colds, chest infections, cold sores and shingles. Antibody levels in the blood may fall over time. A possible small increase in breast cancer risk has been reported.
Get urgent medical help for difficulty breathing, swelling of the face or throat, or feeling faint during or after an infusion; fever, chills or other signs of a serious infection; yellow skin or eyes; or new or worsening weakness, clumsiness, confusion, memory problems or changes in vision or speech, which could be signs of a rare brain infection.
Pregnancy and Lactation
Ocrelizumab should be avoided in pregnancy unless the neurologist decides the benefit outweighs the risk, because it can lower B cells in the baby. Women who can become pregnant should use reliable contraception during treatment and for several months after the last dose, as advised by the doctor. Discuss breastfeeding with your doctor before starting.
Precautions and Warnings
Hepatitis B and other infection screening is done before starting. Tell your doctor about any current infection, previous hepatitis, recent vaccines or plans for pregnancy. Women should follow routine breast cancer screening. Delay the infusion if you have an active infection.
Overdose
As it is given by health professionals, overdose is unlikely. If too much is given, the patient is monitored and given supportive care.
Therapeutic Class
Monoclonal antibody (anti-CD20); immunomodulator for multiple sclerosis.
Storage
Store in a refrigerator at 2 to 8°C. Do not freeze or shake. Keep the vial in its carton to protect from light. Diluted solution is used as directed by the hospital pharmacy. Keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.