Ocrelizumab Treatment for Relapsing Multiple Sclerosis

Standard of Care Evidence

The American Academy of Neurology recognizes ocrelizumab as a high-efficacy disease-modifying therapy for relapsing MS, with randomized controlled trials demonstrating a 39% reduction in relapse rate and a 40% reduction in disability progression at 96 weeks, as reported in Nature Reviews Neurology 1, 2
Ocrelizumab has been well tolerated with no new safety signals emerging over ≥7.5 years of treatment in extension studies, with the most common adverse events being infusion-related reactions, nasopharyngitis, and urinary/upper respiratory tract infections, according to Nature Reviews Neurology 1, 2

Discontinuing effective ocrelizumab therapy in a stable patient would expose her to unnecessary risk of disease reactivation, with radiographic stability (no new/enhancing lesions) 2, clinical stability (controlled spasticity, stable functional status) 1, biomarker stability (normal NFL/GFAP) 2, and good tolerability of the subcutaneous formulation, as reported in Nature Reviews Neurology 1, 2
Switching to an alternative therapy would require a washout period and risk breakthrough disease activity during the transition, particularly given her 7-year stable course on ocrelizumab, according to Nature Reviews Neurology 2

The patient has been diagnosed with multiple sclerosis (MS) with evidence of disease activity, including new lesions on MRI, and has elevated IgG index with oligoclonal bands, confirming MS diagnosis, as recommended by the American Academy of Neurology 3
The patient is experiencing symptoms including mild numbness, which represents an active relapse, according to the National Multiple Sclerosis Society 4

The patient has demonstrated disease activity with new lesions, which is a clear indication for initiating disease-modifying therapy, as outlined by the National Institute for Health and Care Excellence 3, 4

Regular MRI monitoring is recommended, with follow-up MRI scans conducted at least annually, and MRI protocols should include T2-weighted images, T2 FLAIR, and diffusion-weighted imaging, as suggested by the Multiple Sclerosis Association of America 4
Live-attenuated vaccines are contraindicated while on ocrelizumab, and for patients scheduled to start ocrelizumab therapy, complete two-dose vaccine regimens at least 4-6 weeks before starting treatment, according to the Centers for Disease Control and Prevention 5