Ocrelizumab

How it works

It binds CD20 on B lymphocytes and depletes them through cell-mediated and complement-dependent mechanisms, reducing B-cell-driven inflammatory activity.

Prescribing in practice

• Infusion-related reactions are common, so premedication and a slow monitored infusion with post-infusion observation are required.
• Screen for hepatitis B before starting because reactivation can occur, and avoid live vaccines during B-cell depletion.
• Long-term B-cell depletion increases infection risk and serious infections should prompt review.

Monitoring

Monitor for infusion reactions, signs of infection, immunoglobulin levels and hepatitis B status throughout treatment.

Counselling the patient

• Infusions are given periodically with monitoring during and after each dose.
• Complete recommended vaccinations beforehand and avoid live vaccines while on treatment.
• Report fevers, persistent infections or any new neurological symptoms.

Evidence & guidelines

The OPERA and ORATORIO trials established the efficacy of ocrelizumab in relapsing and primary progressive multiple sclerosis respectively.