Should my husband switch to Ocrevus?

Here is My Question:
My husband has MS and is on Gilenya about 5 years and feels good. He has been in a wheelchair 8 years. The doctor saw lesions on the MRI wants him to switch to Ocrevus a new infusion. We are concerned about getting more lesions during the washout phase. This happened when he switched from Tysabri to Gilenya 5 years ago he washed out for 5 months and got real sick and 7 lesions. But the Gilenya was better. If there are no new lesions for 5 years but some new activity is on the MRI now should he switch to Ocrevis now or wait and see for a while? We understand no medicine is 100%. Does this mean the Gilenya has stopped working or is this to be expected?

Answer:
It can be very difficulty to interpret changes on MRI scan in people with longstanding MS and significant disability (for instance, being wheelchair bound).  If repeat MRIs are not obtained and analyzed correctly, neurologists and radiologists may mistakenly interpret scans as active when the scan is, in fact, stable and vise-versa.  Therefore, I find it very difficulty to answer this type of question without personally reviewing the MRI scans and knowing more about the person.

I agree with you on the wash out period. If you switch wait no more than a month between stopping Gilenya and starting Ocrelizumab 

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego