Is Lemtrada or Ocrevus better for younger people with multiple sclerosis?

Here is My Question:
I was diagnosed with MS at the end of 2015. Currently on Tysabri since 6/2016 because Copaxone did not work. My most recent MRI shows new lesions. I will need to decide between Lemtrada and Ocrevus. Are there benefits of one versus the other? I'm female, 36 years old. lesions in brain, brainstem, and spinal cord. I can still walk, but it takes more effort. From what I've heard, Lemtrada is best early on in the game and better for younger patients. What do you think?

Answer:
Both therapies are highly effective in MS.  Ocrevus (ocrelizumab) is less toxic in my opinion and likely safer (especially if you consider our experience with rituximab).  Lemtrada has autoimmunity issues, although the dosing is once annually.  Ocrelizumab or off-label use of rituximab would be dosed roughly semiannually and does not have the autoimmunity issues that Lemtrada does.  Also, Ocrelizumab (and the phase 2 data of rituximab) suggest a positive effect on primary progressive MS as well. 

As I don't know your specific case, it is hard to say.  I would add that Dr. Kinkel and myself published data on the use of low dose rituximab (100mg) in those who failed other therapies, including tysabri, and we found that it did a very good job of controlling the disease.  The reference for that paper is:  Mult Scler. 2012 Mar;18(3):377-8.

It would be best to discuss with your neurologist those particular issues.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente
KP Fontana and Riverside Medical Centers