Should I switch from Tecfidera to Ocrevus?

Here is My Question:
I was diagnosed with MS in 2001. I have had 2 children and was on Copaxone for 10 years. Altered sensation in both feet and legs to knees began while on Copaxone. Had a small spinal lesion that causes altered sensation in my right forearm and hand. I switched to Tysabri for a little over a year because I became JC positive. I have been on Tecfidera for a few years now and my neurologist wants me to switch to Ocralizmab.

My head is full of lesions, but no new enhancements on MRI while on Tecfidera. I am still employed full time as a PT in the hospital setting. It is now more difficult to walk I can feel my legs having difficulty firing and I don't think I could run to save my life. My question is do you think I should continue Tecfidera or start ocralizmab? I'm scared the side effects may make it harder to continue working as a PT in the hospital setting. Again, I have a bunch of lesions, but no new enhancements on MRI. 

Answer:
You may be transitioning to a secondary progressive stage (not sure). Ocrelizumab or rituximab are good options and have more data to support their use to slow down progression (particularly if you still are at risk of inflammatory MS activity). Experience to date suggests that your risk of PML is greater on Tecfidera than the b-cell depleting biologics. Moreover, side effects are far more common and pervasive on the oral therapies.  

I'd suggest speaking with your neurologist to share your concerns but also to explore why your physician is really recommending a b-cell biologic based on your particularly history.  From a work standpoint, the infrequency of the infusions would pose minimal intrusion in your work schedule.

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