Kesimpta, Tysabri, and More: 8 Injections and Infusions for Multiple Sclerosis
For people living with multiple sclerosis (MS), many injectable medications are available to manage the condition. Here are eight MS injections and infusions to know.
Ocrevus
Used for Multiple Sclerosis
Used for Multiple Sclerosis
Ocrevus (ocrelizumab) is used to treat multiple sclerosis (MS) in adults. It can also treat certain children 10 years and older with relapsing-remitting MS. Ocrevus (ocrelizumab) is a type of monoclonal antibody. It's given as an infusion through the vein every 6 months at a medical center or clinic. A trained healthcare professional will help give Ocrevus (ocrelizumab) to you. Side effects can include a higher risk of infections and infusion reactions.
What is Ocrevus (ocrelizumab)?
What is Ocrevus (ocrelizumab) used for?
- All types of multiple sclerosis (MS) in adults
- Relapsing-remitting MS in children 10 years and older who weigh at least 55 lbs
How Ocrevus (ocrelizumab) works
Ocrevus (ocrelizumab) is a monoclonal antibody. It's not exactly known how the medication works to help with MS.
But scientists think it attaches to a protein called CD20 found on immune cells in the body. It destroys these immune cells so they can't attack the coverings on your nerve cells by mistake. This might help relieve symptoms of MS.
When does Ocrevus (ocrelizumab) start working?Time passed since treatment started:
Drug facts
| Common Brands | Ocrevus |
|---|---|
| Drug Class | Monoclonal antibody |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
More on Ocrevus (ocrelizumab) essentials
Side effects of Ocrevus (ocrelizumab)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Upper respiratory tract infections (40%)
- Infusion reactions (34%)
Less Common Side Effects
- Back pain
- Pain in arm or leg
- Depression
- Herpes infections
- Lower respiratory tract infections
Note: Side effects were from adults. Side effects were similar for children with MS.
Ocrevus (ocrelizumab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious infusion reaction: hives, rash, itching, flushing, dizziness, tiredness, fever, headache, pain in mouth or throat, neck swelling, trouble breathing, fast heart rate, nausea,
- Serious infection: fever, chills, weakness, sweating, trouble breathing, cough
- Inflammation of the colon: severe stomach pain, cramping, diarrhea, bloody stools
- Liver damage: feeling very tired, loss of appetite, nausea, vomiting, pain on the upper right side of your stomach, dark urine, yellowing of your skin or the whites of your eyes
When do Ocrevus (ocrelizumab) possible side effects begin and end?
Time passed since treatment started:
M
H
D
W
M
Y
Risk of infusion reaction
Risk of liver damage
Risk of serious inflammation in the colon
Seek immediate medical care if you experience this side effect.
More on Ocrevus (ocrelizumab) side effects
The following Ocrevus (ocrelizumab) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Breast tissue changes, new lumps, redness, pain, or discharge from the nipple
- Dizziness, loss of balance or coordination, confusion or trouble speaking
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Infusion reactions—chest pain, shortness of breath or trouble breathing, feeling faint or lightheaded
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Sudden or severe stomach pain, bloody diarrhea, fever, nausea, vomiting
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Back pain
- Diarrhea
- Swelling of the ankles, hands, or feet
- Worsening mood, feelings of depression
Pros and cons of Ocrevus (ocrelizumab)
Pros
- Given twice a year (after a couple starter doses)
- Can help lessen the number of MS relapses
- Approved for all types of MS in adults
- Also approved for MS in certain children ages 10 years and older
- Might be better tolerated than some other injectable MS medications
Cons
- Must be given as an infusion through the vein
- Each infusion takes a few hours
- Can cause infusion reactions (like itching, flushing, nausea, and fast heartbeat)
- Can raise your risk of infections
- Doesn't cure MS
Pharmacist tips for Ocrevus (ocrelizumab)
- After the first two infusions, get your Ocrevus (ocrelizumab) infusion every 6 months. Put down the date of your infusions in your calendar so you don't forget.
- If you miss an Ocrevus (ocrelizumab) infusion, call your care team to reschedule it as soon as possible. Then, your next infusion will be 6 months later. Each infusion must be at least 5 months apart.
- Make sure to plan ahead for your Ocrevus (ocrelizumab) infusion. Each infusion takes at least 2 hours. And, you'll also need to stay at the center for at least another hour after the infusion ends. This is so your care team can check for delayed reactions to the infusion. Bring a book, something else to do, or snacks with you to help pass the time.
- If you feel itchy, dizzy, or nauseous during your infusion, tell the nurse right away. Also let them know if you get a rash, have pain in your mouth or throat, or have trouble breathing. These can be signs of an infusion reaction. Your nurse can slow or stop your Ocrevus (ocrelizumab) infusion. They can also give you medications to help relieve these reactions.
- Get medical help right away if these infusion reactions happen after you've gone home. Reactions can happen up to a day after the Ocrevus (ocrelizumab) infusion.
- Ocrevus (ocrelizumab) can make it more likely for you to get an infection. Call your care team if you think you've gotten sick so you can get treated appropriately. Watch for signs of an infection, like fever, chills, weakness, cough, or muscle aches.
- Before getting any vaccines, tell the healthcare professional that you're taking Ocrevus (ocrelizumab). They can help make sure the vaccine is safe for you to get. You shouldn't get any live vaccines while taking this medication. It's not known if it can make you more likely to get sick from a live vaccine.
- If you can become pregnant: Use reliable birth control while you're taking Ocrevus (ocrelizumab). Keep using birth control for 6 months after your last infusion. This medication might harm an unborn baby. If you get pregnant during treatment, tell your prescriber right away.
- If you plan to breastfeed: Talk to your prescriber about the risks and benefits. We don't know if Ocrevus (ocrelizumab) can pass into breast milk. We also don't know if it can affect your milk supply and your baby. Speak to your prescriber or a lactation specialist to choose a safe feeding option.
Risks and warnings for Ocrevus (ocrelizumab)
Ocrevus (ocrelizumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Infusion reactions
Ocrevus (ocrelizumab) can cause reactions up to a day after the infusion. You might feel itchy, flushed, dizzy, or nauseous. You also might have hives, pain in the mouth or throat, a fast heart rate, or other signs of anaphylaxis. Neck swelling and trouble breathing can be very serious.
Your care team might give you a few medications about 30 minutes to 1 hour before your Ocrevus (ocrelizumab) infusion. These medications include a steroid and an antihistamine. They also might give you acetaminophen (Tylenol). This helps lower the risk and severity of infusion reactions.
The nurse will watch for reactions during each of your Ocrevus (ocrelizumab) infusions. But let them know if you have any reactions at any time during your infusion. They can slow or stop the infusion and give you medications to help.
Your care team will also watch you for at least another hour after the infusion ends. This helps them look for and attend to any delayed reactions. Get medical help right away if you have an infusion reaction when you're back at home.
Risk of serious infections
- Risk factors: Active, chronic (long-term), or recurrent infection | Other conditions that raise your risk of infection | Taking medications that weaken your immune system
Ocrevus (ocrelizumab) can weaken your immune system and make it harder to fight off germs. This can raise your risk of getting infections from bacteria, viruses, or fungi. Some infections include respiratory infections, skin infections, and herpes infections. Sometimes, they can be very serious. For example, it's rare but possible to get a serious brain infection called progressive multifocal leukoencephalopathy (PML).
Before starting Ocrevus (ocrelizumab), tell your prescriber about your medical history. If you're sick, don't start treatment until you get better. Your prescriber will also check for hepatitis B. This infection can come back during treatment and cause serious problems. Your prescriber will make sure this medication is safe for you.
Also let your prescriber know about all the medications you take. It's important to check if you take other medications that can weaken your immune system. This can make your risk of infections even higher.
Call your care team if you have signs of infection. Watch for a fever, chills, cough, trouble breathing, weakness, or a rash. If you're sick, you might need to stop treatment until you're better.
Get medical help right away if you feel weak on one side, have vision changes, feel clumsy, or have trouble thinking or remembering. These could be signs of a serious brain infection that needs medical care.
Lower antibody levels
Ocrevus (ocrelizumab) can lower the levels of certain immunoglobulins (antibodies) in your body. This might put you at risk of serious infections.
Your prescriber will check your antibody levels with blood tests while you're taking Ocrevus (ocrelizumab). They'll keep checking even after you stop until your levels are back to normal. If your antibody levels are too low, your care team can help decide what to do next. For example, immunoglobulin infusions might help bring your levels up.
Serious inflammation of the colon
Although rare, some people who took Ocrevus (ocrelizumab) had colitis. This is when the colon gets inflamed or swollen. It's happened from a few weeks to years after starting Ocrevus (ocrelizumab). Some cases have been serious and needed other medications to help treat it. Sometimes, people needed to go to the hospital or get surgery for this problem.
Your prescriber will monitor you for this gut problem while you're taking Ocrevus (ocrelizumab). Tell your care team right away if you have stomach pain, cramping, diarrhea, or bloody stools. They can see if there's something serious going on.
Liver damage
Some people taking Ocrevus (ocrelizumab) have had liver damage. This can show up as high liver enzyme levels in the blood. It can happen weeks to months after an infusion. Very high liver enzyme levels can raise the risk of severe liver injury.
Your prescriber will check your liver with blood tests before you start Ocrevus (ocrelizumab). They'll make sure the medication is safe for you to take.
Watch for signs of liver problems during treatment. This can include tiredness, loss of appetite, nausea, vomiting, pain on the upper right side of your stomach, dark urine, or yellow skin or eyes. If you notice these, tell your prescriber right away so they can check it out. If there's liver damage, you might need to stop Ocrevus (ocrelizumab).
Possible higher risk of cancer
It's rare, but there might be a possible higher risk of cancer with Ocrevus (ocrelizumab). In studies, cases of cancer, including breast cancer, happened more often in people who took Ocrevus (ocrelizumab) . This was in comparison to those who took either a different MS medication or placebo.
Talk to your prescriber about the risk of cancer with Ocrevus (ocrelizumab). They can talk to you about getting screened for cancer, including any tests or exams you might need. They can also tell you the signs of cancer to watch for during treatment. Call your care team if you notice anything unusual.
Ocrevus (ocrelizumab) dosage
Typical dosage for Ocrevus (ocrelizumab)
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Adults: The typical starting dose is 300 mg infused into the vein (intravenously or IV) given once and then again 2 weeks later. After that, the maintenance dose is 600 mg given as an IV infusion every 6 months.
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Children 10 years and older: The dose is based on your child's weight.
- Weighing 77 lbs or more: The typical starting dose is 300 mg given as an IV infusion once and then again 2 weeks later. After that, the dose changes to 600 mg given as an IV infusion every 6 months.
- Weighing 55 lbs to less than 77 lbs: The typical starting dose is 150 mg given as an IV infusion once and then again 2 weeks later. After that, the maintenance dose is 300 mg given as an IV infusion every 6 months.
More on Ocrevus (ocrelizumab) dosage
Ocrevus (ocrelizumab) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Ocrevus (ocrelizumab) will not be safe for you to take.
- Active hepatitis B infection
- Life-threatening infusion reaction to Ocrevus (ocrelizumab)
What are alternatives to Ocrevus (ocrelizumab)?
There are a number of medications that your doctor can prescribe in place of Ocrevus (ocrelizumab). Compare a few possible alternatives below.
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