What lab tests should be run when taking Ocrevus and how long can I safely take it?

Question:
Are there specific lab tests that should be run during Ocrevus treatment and if so at what intervals? My concern is being immunocompromised. Are there any supplements or vitamins that can be taken to safely combat this risk? In theory - how long can a patient safely be on a drug like Ocrevus?

Answer:
All patients must be tested for Hepatitis B before starting Ocrevus; we also recommend testing for Hepatitis C since so many people are infected with this virus and not aware of it.

We also check CD19 counts before treatment and quantitative immunoglobulin levels (IgG, IgA, IgM). Ocrevus works by destroying the CD19 + (CD20 +) lymphocytes in circulation and knowing the baseline count is helpful in determining dosing intervals at a later date.

We want to know baseline immunoglobulin levels since Ocrevus can cause immunoglobulin deficiency and make you more susceptible to infections, particularly upper respiratory infections. Some people even have immunoglobulin deficiency before starting Ocrevus and this is useful to know ahead of time. Lastly, we check a complete blood count (CBC with auto diff) and complete metabolic profile before starting treatment and before every subsequent treatment.

There are no supplements to help with preventing infections. Infections are relatively rare with Ocrevus and more common if you are older, have other risk factors like pulmonary disease or frequent UTIs or spend anytime in a wheelchair.

Good luck

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