Ocrelizumab

How it works

It binds CD20 on B lymphocytes and depletes them, reducing the B-cell-mediated inflammation and demyelination that drive multiple sclerosis activity.

Prescribing in practice

• Screen for hepatitis B before starting, as reactivation can occur with B-cell depletion, and ensure infections are treated before each infusion.
• Infusion-related reactions are common, so give premedication and administer where reactions can be managed.
• There may be an increased long-term risk of infections and malignancy, so maintain vaccination and screening as appropriate.

Monitoring

Monitor for infections and infusion reactions, with hepatitis B screening and immunoglobulin levels checked as clinically indicated.

Counselling the patient

• Complete recommended vaccinations before treatment begins, as live vaccines are not advised during therapy.
• Report signs of infection promptly between infusions.
• Tell your team about symptoms during or shortly after an infusion.

Evidence & guidelines

Ocrelizumab reduced relapses in relapsing multiple sclerosis and slowed progression in primary progressive disease in pivotal trials, and is recommended by NICE for eligible patients.