Should I delay my Ocrevus Treatment?

Here is My Question:
If my MS symptoms are coming back with a vengeance, like SEVERE cognitive issues and trouble with memory and conversation, bad nystagmus making me nauseated and hard to drive, unbearable MS hug spasm (hard to handle), and just complete confusion and tremor and just feeling awful, AND I am told to delay my Ocrevus (which is obviously sound advice right now), would it be wise to check an MRI to make sure I don’t have an acute worsening and may need it and just completely isolate? I hate the idea of taking it and chancing my life and I was all on board to delay it until the last few days. I am just in terrible shape and hoping it’s not an actual relapse. My specialist is SO hard to contact and takes weeks to get responses. This is just a very difficult time and I need help or encouragement.

Answer:
The answer to your question depends a lot on your individual circumstances. It would not be possible for me to determine, based on the information provided, whether or not you are experiencing a relapse or activation of your MS. What I can do is provide so information that may help reassure you.

1. If you've been receiving Ocrevus every 6 months for several cycles and are simply due for your next cycle, it is very unlikely you have any circulating central memory or even naive B cells. If this is the case their is very little evidence that treating you now is required or will resolve your current symptoms. In fact this would be an indication that you are a non responder to Ocrevus and re-treatment may be of little benefit. If its been a year or more since your last cycle of Ocrevus it is possible that your disease is reactivated only if you are younger (< 50) with relapsing MS
2. If you are on Ocrevus for progressive MS, it is important to realize that the clinical trials showed marginal  benefits from treatment with this drug. It is also important to realize that those benefits were only demonstrated in those people under 55 years old. If you are older than 55 we do not have evidence of benefit, mostly because people over 55 were excluded from the trials
3. People over 50, especially those over 60, are at highest risk of complications from COVID 19 (see blog on risk factors for COVID 19 complications). This is particular true of men and those with hypertension, diabetes, heart disease and likely smokers. If you are in this group you have a particular reason to delay Ocrevus infusions.

Overall, younger people (< 45) with relapsing, active MS (relapse and MRI activity in the year prior to starting Ocrevus ) are the individuals who respond best to Ocrevus and need it most, but even these individuals may be able to delay treatment if they've already received several every 6 month cycles.

Good luck

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