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PPMS – Ocrelizumab — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationPPMS – OcrelizumabSCE Neurology

Before the first ocrelizumab infusion for active primary progressive MS, which safety preparation is essential?

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Correct answer: B — Complete HBV infection screening, update vaccines and review infection risk

The best answer is “Complete HBV infection screening, update vaccines and review infection risk”. Anti-CD20 treatment can reactivate HBV infection and blunts vaccine responses. Infection screening, immunisation review and timing of live vaccines therefore precede infusion. The alternatives “Infuse first and review infection risk after B-cell depletion”, “Administer required live vaccines during active B-cell depletion”, “Use tuberculosis testing as the complete infection screen”, “Avoid every inactivated vaccine after treatment starts, after excluding important mimics” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG220 multiple sclerosis recommendations: https://www.nice.org.uk/guidance/ng220/chapter/Recommendations