ocrelizumab at a glance
Medicine class
Anti-CD20 humanised monoclonal antibody
Licensed uses
Active relapsing MS and selected early primary progressive MS in adults
How it is given
By intravenous infusion or injection under the abdominal skin, given by healthcare professionals
Important safety issue
It reduces B cells, which can increase infection susceptibility and weaken vaccine responses
What is ocrelizumab used for?
Licensed adult uses are:
Relapsing forms of MS with active disease shown by clinical attacks or imaging.
Early primary progressive MS, considering disease duration and disability, with imaging features of inflammatory activity.
How does ocrelizumab work?
Ocrelizumab binds CD20 on selected mature and memory B cells, causing their depletion. These cells contribute to abnormal immune activity that damages myelin in MS. Stem cells and antibody-producing plasma cells do not express CD20 and are not directly targeted.
ocrelizumab preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 300 mg
Injection
Route: Parenteral
Strengths: 920 mg
How to take ocrelizumab
Ocrelizumab is given in a specialist setting. A corticosteroid and antihistamine are given beforehand to reduce administration reactions.
The intravenous concentrate is diluted in sodium chloride and infused through a dedicated line; it must not be given as an intravenous push or bolus.
The subcutaneous formulation is ready to use and injected into suitable abdominal skin under healthcare-professional supervision.
Patients are observed during and after administration for reactions.
ocrelizumab side effects
Common or expected effects
- Upper respiratory infections, sore nose or throat, influenza, sinusitis or bronchitis
- Herpes infections, including cold sores or shingles
- Cough or catarrh
- Infusion reactions, including itching, rash, flushing, fever, headache, dizziness, nausea or throat irritation
- Subcutaneous injection reactions, including redness, pain, swelling or itching
- Reduced immunoglobulin levels and, less often, reduced neutrophils
Get urgent medical advice
- Severe infusion, injection or allergic reaction, including breathing difficulty, throat swelling, marked low blood pressure or anaphylaxis
- Serious or persistent infection, including pneumonia
- New or worsening neurological symptoms that could indicate progressive multifocal leukoencephalopathy
- Hepatitis B reactivation in someone with current or previous infection
- Severe or delayed neutropenia associated with infection
ocrelizumab in pregnancy
Pregnancy data are limited. Ocrelizumab should be avoided during pregnancy unless expected maternal benefit outweighs potential fetal risk. Discuss pregnancy planning or an unexpected pregnancy promptly with the MS specialist. Exposure in the womb may reduce an infant's B cells, and the clinical team may need to check B-cell recovery before live vaccines are given.
ocrelizumab while breastfeeding
Ocrelizumab can be used while breastfeeding starting a few days after birth. Small prospective studies found low transfer into milk, undetectable concentrations in tested infant blood and normal measured infant B-cell levels. Discuss treatment and infant vaccination plans with the specialist team.
ocrelizumab interactions
Conventional metabolic interactions are not expected, but immune-system interactions are important.
Live or live-attenuated vaccines
Not recommended during treatment or until B-cell recovery because safety has not been established.
Non-live vaccines
May be given when appropriate, but antibody responses can be reduced.
Common questions about ocrelizumab
Answers are fully visible for fast scanning and source review.
Does ocrelizumab cure MS?
No. It reduces inflammatory MS activity and does not reverse all established nerve damage.
Is it used for primary progressive MS?
Yes, for selected adults with early primary progressive MS and imaging evidence of inflammatory activity.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.