Ocrevus Treatment: Hospitalization And Side Effects Explained

Ocrevus (ocrelizumab) is a prescription drug used to treat certain relapsing forms of multiple sclerosis (MS) and primary progressive MS. It is administered by a healthcare provider in a hospital, clinic, or at home. Ocrevus suppresses the immune system, increasing the risk of infections such as colds, influenza, herpes, and other viral infections. In addition, it may cause infusion and injection reactions, which can be serious and require hospitalization. Patients are monitored during and after administration for signs of side effects, and treatment adjustments or medications may be used to manage reactions. Ocrevus may also increase the risk of cancer and cause immune-mediated colitis, which can be severe and require hospitalization or surgery.

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Infusion and injection reactions

Ocrevus (ocrelizumab) is a prescription drug used to treat certain relapsing forms of multiple sclerosis (MS) and primary progressive MS. It is administered either by infusion (intravenous drip) or injection under the skin.

During the administration of Ocrevus, patients are monitored for signs and symptoms of infusion or injection reactions. For Ocrevus, monitoring occurs during the infusion and for at least an hour afterward. For Ocrevus ZUNOVO, the first injection is monitored for at least an hour, while subsequent injections are monitored for at least 15 minutes.

Reactions can occur during or up to 24 hours after administration. Patients are advised to contact their healthcare provider immediately if they experience any symptoms during or after treatment. Symptoms may include infusion site skin discolouration or swelling.

If a patient experiences an infusion reaction, the rate of infusion may be slowed down or stopped to alleviate the reaction.

Increased risk of infection

Ocrevus (ocrelizumab) is a prescription drug used to treat certain relapsing forms of multiple sclerosis (MS) and primary progressive MS. It is usually administered by a healthcare provider in a hospital, clinic, or at home.

Ocrevus suppresses the immune system, increasing the risk of infection. Upper and lower respiratory tract infections, skin infections, and herpes infections are the most commonly reported infections in people using Ocrevus. Upper respiratory infections, such as the common cold, were more frequently reported than lower respiratory infections, such as pneumonia. In rare cases, these infections can be severe and life-threatening.

Ocrevus may also increase the risk of hepatitis B virus reactivation. Patients with a history of hepatitis B may experience reactivation of the virus while on Ocrevus treatment. Blood tests and monitoring during and after treatment may be necessary for these patients.

In addition to the above, Ocrevus may increase the risk of progressive multifocal leukoencephalopathy (PML), a serious and often fatal brain infection. PML occurs when the immune system in the brain and spinal cord is suppressed, allowing a previously dormant virus to become active and cause disease. The risk of PML may persist even after discontinuing Ocrevus, as it can take several months for the immune system to recover.

It is important to note that not all side effects of Ocrevus are related to increased infection risk. Infusion and injection reactions are also common and can be serious, requiring hospitalisation. Patients are typically monitored during and after Ocrevus administration to watch for any signs or symptoms of these reactions.

Cancer risk

Ocrevus is a drug that reduces immune system activity. It is associated with an increased risk of developing certain types of cancer, particularly breast cancer. This risk is rare, but it has been observed in clinical trials, with a higher rate of cancer development in patients taking Ocrevus compared to those on a placebo or similar drug.

In three main clinical trials, six out of 781 females (<1%) were diagnosed with breast cancer. While the link between Ocrevus and cancer is contested, and it is unclear if Ocrevus directly raises the risk of cancer, the FDA recommends that patients taking Ocrevus follow standard breast cancer screening guidelines.

Women under 40 with risk factors for breast cancer (genetic or environmental) should consult their healthcare provider about the advisability and frequency of mammograms. Women over 40 should follow current breast cancer screening guidelines, which recommend that females over 45 have a mammogram every one or two years.

Other side effects of Ocrevus include an increased risk of certain infections, such as respiratory infections, skin infections, and herpes infections, as well as colitis and liver damage.

Hepatitis B reactivation

Ocrevus (ocrelizumab) is an anti-CD20 monoclonal antibody used to treat primary progressive (PP) and relapsing (R) multiple sclerosis (MS). It is closely related to rituximab.

Ocrevus can cause hepatitis B virus (HBV) reactivation in patients with resolved HBV infections. HBV reactivation can cause serious liver problems, including fulminant hepatitis, hepatic failure, and even death. Patients with active hepatitis B or a history of the infection should not take Ocrevus. Before starting treatment, healthcare providers will perform blood tests to check for hepatitis B viral infection. If there is a risk of HBV reactivation, patients will be monitored during treatment and up to six months after treatment. Treatment for HBV reactivation typically involves entecavir, which has been shown to be effective and safe.

Progressive multifocal leukoencephalopathy

PML is typically diagnosed through a brain biopsy or by combining observations of the disease's progressive course, consistent white matter lesions on a magnetic resonance imaging (MRI) scan, and the detection of the JC virus in spinal fluid. The most prominent symptoms of PML include clumsiness, progressive weakness, and visual, speech, and sometimes personality changes. Lesions affecting specific areas of the brain, such as the parietal and occipital lobes, can lead to a phenomenon known as alien hand syndrome.

The treatment approach for PML focuses on reversing the immune deficiency to slow or stop the disease's progression. For individuals on immunosuppressive medications, this may involve stopping the drugs or using plasma exchange to accelerate the removal of the biologic agent contributing to PML risk. In HIV-infected individuals, initiating highly active antiretroviral therapy (HAART) is crucial. While there are no drugs that effectively inhibit or cure the virus infection without toxicity, some AIDS patients with PML have survived for several years with HAART.

Although rare, PML carries a high mortality rate of 30-50% in the initial months, and survivors often experience varying degrees of neurological disabilities. PML primarily affects individuals with severe immune deficiencies, such as those with acquired immune deficiency syndrome (AIDS) or those undergoing immunosuppressive therapy for organ transplants. Individuals with autoimmune conditions, such as multiple sclerosis or rheumatoid arthritis, who receive biological therapies, are also at risk for PML.

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