Ocrelizumab – Pre-Treatment Investigations — SCE Neurology MCQ

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EasyMultiple Sclerosis & CNS InflammationOcrelizumab – Pre-Treatment InvestigationsSCE Neurology

A 35-year-old woman with MS is starting ocrelizumab. Her neurologist orders baseline investigations before the first infusion. What pre-treatment investigations are required before starting ocrelizumab?

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Correct answer: B — FBC, hepatitis B (HBsAg, anti-HBc, anti-HBs), hepatitis C, quantitative immunoglobulins, and varicella zoster IgG — vaccinations should be completed at least 6 weeks before the first infusion

Before starting ocrelizumab (anti-CD20), the following pre-treatment investigations are required: (1) FBC (baseline lymphocyte count), (2) Hepatitis B serology (HBsAg, anti-HBc, anti-HBs) — HBV reactivation risk, (3) Hepatitis C antibody, (4) Quantitative immunoglobulins (IgG, IgM, IgA) — baseline for monitoring hypogammaglobulinaemia, (5) VZV IgG — vaccinate if non-immune (at least 6 weeks before starting), (6) All recommended vaccines should be completed before treatment (live vaccines contraindicated once started). A: Multiple investigations are mandatory. C: FBC alone is insufficient. D: Multiple serologies needed. E: Thyroid monitoring is for alemtuzumab, not ocrelizumab.

Reference: Ocrelizumab SmPC; NICE TA533; ABN MS Guidelines (2022)