From the Guidelines
Prior to an ocrelizumab infusion, you should get a complete blood count (CBC), hepatitis panel, and tuberculosis (TB) testing, as these are commonly obtained tests in patients starting biologic therapies, including ocrelizumab, as suggested by a consensus statement from the Medical Board of the National Psoriasis Foundation 1. When considering the necessary labs before an ocrelizumab infusion, it's essential to focus on tests that can help identify potential risks associated with the treatment, such as infections, hepatitis B reactivation, and changes in blood cell counts.
- A chemistry screen with liver function tests is also recommended, as it can provide valuable information about the patient's liver health before starting the treatment.
- Additionally, TB testing is crucial, as biologic therapies, including ocrelizumab, can increase the risk of reactivating latent TB infections 1.
- While the provided evidence primarily discusses the use of biologics in patients with psoriasis, the principles of monitoring and testing can be applied to patients receiving ocrelizumab for other conditions, such as multiple sclerosis.
- It's also important to note that patients should be periodically re-evaluated for the development of new symptoms, including infection and malignancy, while being treated with biologics 1.
- Furthermore, treatment with biologics is contraindicated in patients with active, serious infections, and if patients develop serious infections while being treated with a biologic agent, it is prudent to hold the biologic until the infection has resolved 1.
From the FDA Drug Label
2.2 Assessments Prior to First Dose of OCREVUS ZUNOVO Hepatitis B Virus Screening Prior to initiating ocrelizumab treatment, perform Hepatitis B virus (HBV) screening. Serum Immunoglobulins Prior to initiating ocrelizumab treatment, perform testing for quantitative serum immunoglobulins
The labs that should be done prior to an ocrelizumab infusion are:
- Hepatitis B Virus Screening: to check for HBV infection
- Quantitative serum immunoglobulins: to check for low serum immunoglobulins 2
From the Research
Labs Prior to Ocrelizumab Infusion
To determine the necessary labs prior to an ocrelizumab infusion, we must consider the potential risks and side effects associated with this treatment.
- Hepatitis B Virus (HBV) Reactivation: As noted in 3, ocrelizumab can reactivate HBV in patients with resolved HBV infection. Therefore, it is essential to monitor HBV-DNA and HBV surface antigen levels prior to infusion.
- Immunoglobulin Levels: Studies such as 4 have shown that long-term ocrelizumab treatment can lead to hypogammaglobulinemia. Monitoring immunoglobulin levels, including IgM and IgA, may be necessary to assess the risk of infections.
- Complete Blood Count (CBC): Although not directly mentioned in the provided studies, a CBC is often performed prior to infusion to assess the patient's overall blood cell count and detect any potential abnormalities.
- Liver Function Tests (LFTs): As ocrelizumab can cause liver enzyme elevations, LFTs may be necessary to monitor liver function prior to infusion.
- CD19 B-cell Counts: In some cases, CD19 B-cell counts may be monitored to guide extended interval dosing, as seen in 4 and 5.
Additional Considerations
It is crucial to note that the specific labs required may vary depending on the individual patient's medical history, disease activity, and treatment protocol. Consultation with a healthcare professional is necessary to determine the necessary labs and precautions prior to ocrelizumab infusion.
- Premedication Protocol: Studies such as 6 have shown that a modified premedication protocol can reduce the incidence of infusion-associated reactions. The necessary labs and premedication regimen should be determined on a case-by-case basis.
- Individual Patient Factors: Factors such as body mass index (BMI), age, and sex may influence the risk of infusion-associated reactions or other side effects, as noted in 6 and 5. These factors should be considered when determining the necessary labs and precautions.