From the Research
JC virus antibody positivity is not a contraindication for starting Ocrevus (ocrelizumab). Patients who test positive for JC virus antibodies can safely begin Ocrevus therapy. Unlike some other multiple sclerosis medications such as natalizumab (Tysabri), Ocrevus has not been associated with an increased risk of progressive multifocal leukoencephalopathy (PML), the serious brain infection caused by JC virus reactivation. Ocrevus works by targeting CD20-positive B cells rather than affecting T-cell trafficking to the brain, which is the mechanism that increases PML risk with natalizumab.
Key Points
- The most recent study 1 shows superior effectiveness of rituximab/ocrelizumab and alemtuzumab compared with fingolimod in stable patients switching from NTZ due to JC virus antibody positivity.
- Another study 2 found that ocrelizumab in JCPyV-DNA positive patients is safe and did not determine PML cases.
- While on Ocrevus, routine JC virus antibody monitoring is not required as it would be with natalizumab therapy. However, patients should still be monitored for any neurological symptoms as a general precaution, and healthcare providers should be aware of the patient's JC virus status as part of their overall medical history.
- The standard Ocrevus dosing regimen consists of 300 mg intravenous infusions given two weeks apart for the first dose, followed by 600 mg infusions every six months thereafter.
Considerations
- A case report 3 described a patient with progressive multiple sclerosis treated with ocrelizumab monotherapy who developed PML, highlighting the importance of discussing the risks and benefits of ocrelizumab, especially in patients at higher risk for infections.
- Overall, the evidence suggests that JC virus antibody positivity is not a contraindication for starting Ocrevus, and patients can safely begin therapy with appropriate monitoring.