I'm concerned about taking Ocrevus because I am JCV positive

Here is My Question:
Hello. I am a 24 year old female. I was diagnosed with MS in 2013. I just found out from my new Neuro that my JCV level is 1.45. I also have lesions on my brain and a C5 lesion in my spinal cord. I used Gilenya a few years ago but stopped due to personal reasons. My Neuro wants me to start taking Ocrevus ASAP but I am concerned because of me testing JCV positive. I fear I will develop PML.

Answer:
Three MS disease modifying therapies have been directly linked to PML. The highest risk is associated with Tysabri. The DMT with the second highest risk is Fingolimod (Gilenya) followed by Tecfidera. To my knowledge there has only been one de novo case of PML in an elderly (over 70 year old) MS patient on Ocrevus. 

As I have discussed previously, we have good mitigation strategies for the prevention of PML with natalizumab and tecfidera. For all DMTs associated with PML, I personally feel one of best mitigation strategies is to avoid using them in elderly patients (over 65). This certainly applies to the use of Ocrevus.

​Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego


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