Switching to Ocrevus (ocrelizumab) within a relatively short period is a safe and effective option for people with relapsing-remitting multiple sclerosis (RRMS) who stop treatment with Tysabri (natalizumab), a small and retrospective analysis suggests.
With a median washout period of six weeks between therapies, the 28 patients in this study had no relapses and there were no reports of progressive multifocal leukoencephalopathy (PML), a viral disease that sometimes occurs in Tysabri-treated patients due to low immune cell numbers in the brain.
The study, “Switching from natalizumab to ocrelizumab in patients with multiple sclerosis,” was published as a letter in the Multiple Sclerosis Journal.
But Tysabri is associated with an increased risk of developing PML, a rare and often fatal viral disease caused by the John Cunningham virus (JCV). PML progressively damages the protective myelin sheath that insulates nerve cells.
A lesser migration of immune cells into the brain with Tysabri’s use is thought to be the reason for this increased PML risk, as not enough immune cells exist to fight the opportunistic infection.
To minimize this infection risk, particularly in people carrying antibodies against the JC virus who are at highest PML risk, patients may opt to switch to a different DMT, such as Ocrevus. But washout periods, which may span two or more months between treatments, can increase disease activity and prompt relapses.
Some MS patients also appear sensitive to “carryover” PML — PML that develops a few months after stopping a DMT associated with this viral disease, and starting a different DMT. This would include switching from Tysabri to Ocrevus.
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