Should I switch from Ocrevus to Zeposia?

Here is My Question:
I have RRMS according to my prior MS specialist but new doctor things it’s possibly PPMS. I’ve been on Ocrevus for about 2 years. He said that according to research and conferences that they are recommending that Ocrevus patients be switched to Zeposia due to new evidence that say Ocrevus may increase severity and frequency of COVID-19. Have you heard anything about this advice or recommendations?

Answer:
I’d suggest another opinion before deciding to transition therapies (especially if you’ve been stable on Ocrevus). At this time, there simply isn't compelling data to firmly conclude a b-cell biological is riskier than a S1P receptor modulator in context of covid infection. Moreover, distinguishing relapsing MS from Primary Progressive MS is not typically a difficult one to make so it seems odd to me that the possibility was communicated to you. Of those two therapies, Ocrevus was approved for PPMS. Another consideration is covid vaccines. It is reasonable to assume that both therapies can limit your response to a covid vaccine, but becoming vaccinated after enough time has elapsed from a b-cell biological treatment is possible since delaying infusion to receive a vaccine is not fraught with concerns about rebound disease activity which is not the case with S1P modulators. I’d request another opinion by a fellowship trained neuro-immunologist who can consider your entire history and response to treatment before making the switch.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente