ocrelizumab: clinical use

Prescribing considerations

• Initiate and supervise through a specialist neurological service with facilities to manage severe administration reactions.
• Assess for active infection and postpone administration until it resolves.
• Screen for hepatitis B before starting; seek hepatology input for previous infection or carrier status.
• Review immunisation status before treatment.
• Consider overlapping pharmacodynamic effects when switching immunosuppressive therapies.
• Use particular caution in primary progressive MS with swallowing impairment because aspiration pneumonia risk may be increased.
• Record product name and batch number for biological traceability.

Contraindications and cautions

• Hypersensitivity to ocrelizumab or a formulation excipient
• Current active infection
• Severely immunocompromised state
• Known active malignancy

Monitoring

• Observe for administration reactions during and afterwards.
• Monitor clinically for infection; consider immunoglobulin levels with recurrent or serious infection.
• Check neutrophils when infection symptoms occur, recognising delayed neutropenia.
• Investigate new or worsening neurological symptoms promptly for possible PML and withhold treatment while PML is suspected.
• Maintain standard age-appropriate cancer screening, including breast screening.

Clinical pharmacology

Ocrelizumab is an IgG1 humanised monoclonal antibody that depletes CD20-expressing B cells through antibody-dependent and complement-mediated mechanisms and apoptosis. It is cleared mainly by protein catabolism rather than hepatic metabolism.

Formulation and product differences

• The intravenous product is a concentrate requiring dilution in sodium chloride and a dedicated infusion line.
• The subcutaneous product is a ready-to-use solution containing recombinant human hyaluronidase and is administered into the abdomen.
• The formulations must be checked carefully and used only by their specified routes.

Solution for infusion

Route: Intravenous

Strengths: 300 mg

Injection

Route: Parenteral

Strengths: 920 mg