If a patient is allergic to Ocrevus (ocrelizumab), can they still receive Kesimpta (ofatumumab)?

From the Guidelines

If a patient is allergic to Ocrevus (ocrelizumab), they may still be able to receive Kesimpta (ofatumumab), but caution is warranted and the decision should be made by a healthcare provider after careful consideration. While both medications are anti-CD20 monoclonal antibodies, they have different structures - Ocrevus is a humanized antibody while Kesimpta is fully human, which is similar to ofatumumab, as described in the study 1. This structural difference means that a patient who had an allergic reaction to Ocrevus might not necessarily react to Kesimpta. However, there is still a potential risk of cross-reactivity between these medications due to their similar mechanism of action. Before attempting treatment with Kesimpta, the patient should undergo a thorough evaluation of their previous allergic reaction to Ocrevus, including its severity and nature. If treatment with Kesimpta is pursued, the first dose should be administered under close medical supervision with emergency medications readily available, similar to how ofatumumab is considered for patients intolerant to rituximab, as noted in the study 1. Key considerations for the administration of Kesimpta include:

• The standard Kesimpta dosing regimen involves 20 mg subcutaneous injections at weeks 0,1, and 2, followed by monthly maintenance doses
• Monitoring for potential side effects, such as infusion-related reactions or increased risk of infections
• Careful evaluation of the patient's medical history and current health status to minimize potential risks associated with Kesimpta treatment.

From the Research

Allergy to Ocrevus and Kesimpta Administration

• If a patient is allergic to Ocrevus (ocrelizumab), the possibility of receiving Kesimpta (ofatumumab) depends on the nature of the allergy and the specific reactions experienced by the patient.
• Both Ocrevus and Kesimpta are anti-CD20 B cell depleting drugs used in the treatment of multiple sclerosis (MS) 2, 3.
• While they share a similar mechanism of action, they are distinct medications with different properties and potential side effects.

Cross-Reactivity and Safety

• There is limited information directly addressing the cross-reactivity between Ocrevus and Kesimpta in patients with an allergy to Ocrevus.
• However, studies suggest that ofatumumab (Kesimpta) may have a different safety profile compared to ocrelizumab (Ocrevus), including a lower incidence of infusion-related reactions in some trials 2.
• The decision to administer Kesimpta to a patient allergic to Ocrevus should be made on a case-by-case basis, considering the patient's specific allergy, the severity of their MS, and potential alternative treatment options.

Clinical Considerations

• Patients with an allergy to Ocrevus should undergo a thorough evaluation by a healthcare provider before starting Kesimpta to assess the risk of cross-reactivity and to discuss the potential benefits and risks of treatment 4.
• Monitoring for signs of an allergic reaction or other adverse effects is crucial when initiating Kesimpta in such patients.
• Further research and clinical data are needed to fully understand the safety and efficacy of switching from Ocrevus to Kesimpta in patients with an allergy to Ocrevus.