Pretreating multiple sclerosis patients with antihistamines more extensively and with hydration can significantly reduce — by 60% — the likelihood of infusion-associated reactions that are the most common side effect of Ocrevus (ocrelizumab) use, a pilot study reported.
Data also found that older and male MS patients are less likely to have such reactions to this therapy, while heavier patients are more likely.
The research, “Reduction in ocrelizumab-induced infusion reactions by a modified premedication protocol,” was published in the journal Multiple Sclerosis and Related Disorders.
Infusion-associated reactions (IARs) to Ocrevus — an approved MS therapy developed by Genentech, owned by Roche — were seen to decrease in rate and severity with subsequent administrations in primary progressive MS patients who took part in the ORATORIO Phase 3 trial (NCT01194570). But they remain a challenge for many on Ocrevus, and may cause patients to stop treatment at less experienced centers.
Aiming to lessen the risk of IARs, a team at The University of Chicago established a modified premedication protocol, based on one previously designed for Lemtrada (alemtuzumab), an MS therapy marketed by Sanofi Genzyme. Specifically, the scientists compared the rate of IARs prior to and after implementing the protocol, and evaluated predictors of IARs in patients receiving Ocrevus.
A total of 207 patients were treated with Ocrevus at the University of Chicago Medicine MS Clinic. Their median age was 47 years, and 131 (63.3%) were women. The night before a September 2017 infusion, 110 patients (72 women, 65.5%) on the modified premedication protocol were instructed to take cetirizine (10 mg), ranitidine (75 mg), and encouraged to drink water or other liquids for hydration. Cetirizine is an antihistamine used to relieve allergy symptoms; ranitidine is an antihistamine used to lower stomach acid production.
This regimen was repeated the next day, prior to arrival at the clinic.
Immediately before an Ocrevus infusion, these patients were also given the antihistamine diphenhydramine at 50 mg and the corticosteroid methylprednisolone at 125 mg, both via intravenous infusion, as well as acetaminophen (650 mg), an oral pain and fever medication.
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