Can Ocrevus Be Given When Patient Is On IV Solumedrol?
Yes, Ocrevus (ocrelizumab) can and should be given to patients receiving IV Solumedrol (methylprednisolone), as corticosteroid premedication is actually required before each Ocrevus administration to reduce infusion/injection-related reactions.
FDA-Mandated Premedication Protocol
The FDA label for Ocrevus explicitly requires corticosteroid premedication before administration 1:
- Administer oral premedication (e.g., dexamethasone or an equivalent corticosteroid, and an antihistamine) at least 30 minutes prior to each OCREVUS injection to reduce the risk of injection reactions 1
- In clinical trials, patients received 100 mg IV methylprednisolone prior to each infusion 2
- The addition of an antipyretic (e.g., acetaminophen) may also be considered 1
Clinical Trial Evidence Supporting Concurrent Use
In the pivotal OPERA I, OPERA II, and ORATORIO trials, all ocrelizumab-treated patients received 100 mg IV methylprednisolone before each infusion 2:
- This premedication protocol was standard across 1,311 ocrelizumab-treated patients in these phase 3 trials 3, 2
- Infusion-related reactions occurred in 34-40% of patients despite methylprednisolone premedication, but were predominantly mild to moderate (92.6-96.9% of reactions) 2
- Only 2.4% of patients in OPERA studies and 1.2% in ORATORIO experienced severe infusion-related reactions with this premedication protocol 2
Practical Administration Considerations
The concurrent use of IV methylprednisolone with ocrelizumab is not only safe but reduces infusion-related reactions 2:
- Premedication use, particularly with antihistamines in addition to corticosteroids, was associated with fewer infusion-related reactions 2
- Most infusion-related reactions occurred with the first infusion and decreased with subsequent dosing 2
- Common infusion-related reaction symptoms included pruritus, rash, throat irritation, and flushing, which were effectively managed through infusion rate adjustment and symptomatic treatment 2
Important Clinical Caveat
If the patient is receiving high-dose or prolonged IV corticosteroids for an acute MS relapse (not just premedication), consider the clinical context 4:
- Guidelines suggest that in high-dose or long-term treatments with corticosteroids, certain interventions may be delayed 4-6 weeks after cessation 4
- However, this applies primarily to vaccination timing, not to disease-modifying therapy administration 4
- For active MS disease requiring immunosuppressive therapy, treatment should be prioritized over other considerations 4
Real-World Safety Data
Real-world evidence from a German compassionate use program with 489 PPMS patients confirmed the safety profile when ocrelizumab was administered with methylprednisolone premedication 5:
- Patients received methylprednisolone and an antihistamine before each ocrelizumab infusion 5
- The safety profile was consistent with clinical trials, with generally good tolerability 5
- Nine serious adverse events and 70 non-serious adverse events were reported in 40 patients (8.2%), supporting the safety of this protocol 5