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Should I switch from Tecfidera to Ocrevus?

6/26/2017

 
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
Lori Cabral
6/26/2017 01:30:47 pm

I have PPMS and have had two infusions of ocrelizumab. I know everyone is different and has different reactions but from day one I have noticed a lot. Day one just hours after I finished the infusion my balace was so much better. I have noticed improvements in my balance, walking, pain, vision, hearing, and much more. I was on Tecfadera back in 2014-2015 and never noticed any kind of improvements. I have had flushing with the new medication but that was one of the side effects I had with Tecfadera so no surprise there. Talk to your doctor about this new medication.....oh each infusion is 5 hours long (jyst an fyi).

Linds Levine
6/27/2017 02:08:21 pm

I'm interested to hear about people's experiences with ocreilizumab. My doc's have recommended that I change from Plegridy as it seems that I may be transitioning to secondary progressive.
Haven't experienced any of the usual side effects from either the Avonex or Plegridy that I've been on for several years. Hoping that the trend will continue if I change


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  • Blogs
    • Physician Blog >
      • Healthcare Provider Blog
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      • "Ask Dr. Debbie" Research Blog
      • Multiple Perspectives In Multiple Sclerosis Research Blog
  • About MS
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