Briumvi (Ublituximab-xiiy) vs. Ocrevus (Ocrelizumab)

If your neurologist has recommended an anti-CD20 infusion for multiple sclerosis, you’ve likely come across both Briumvi (ublituximab-xiiy) and Ocrevus (ocrelizumab). 

Both are given intravenously (IV) every six months, both target the same part of the immune system, and both have strong clinical data behind them. The differences in infusion time, approved conditions, and cost can matter a lot in practice.

Here, we’ll break down the key points across how they work, approved indications, infusion schedules, side effects, and cost. If you’re looking for specialty pharmacy support as you start or switch MS treatment, knowing what sets these two apart is a good place to begin.

How Do Briumvi and Ocrevus Work?

Both medications belong to the same class: anti-CD20 monoclonal antibodies, which are lab-made proteins that target a specific part of the immune system. 

They target the same protein on the same type of immune cell and reduce disease activity through the same biological process, which is why their efficacy results for relapsing forms of multiple sclerosis (MS) are closely comparable. The key practical difference is scope of approval: Ocrevus is also FDA-approved for primary progressive MS, while Briumvi is not.

Acelpa Health and its affiliated specialty pharmacies—California Specialty Pharmacy (CSP), ContinuumRx (CRx), Hawaii Specialty Pharmacy (HSP), Continuum Health (CH), and Integrated Care Systems (ICS)—support patients receiving MS therapies, including infusion treatments, handling prior authorization, insurance coordination, and scheduling throughout care.

What Is Anti-CD20 Therapy?

CD20 is a protein on the surface of B cells, a type of white blood cell that plays a significant role in a healthy immune system. 

In MS, B cells malfunction and contribute to the immune attacks that damage myelin, the protective coating around nerve fibers.

Anti-CD20 therapies bind to B cells and flag them, signaling to the body’s immune system to remove them. By removing these overactive, self-attacking B cells, the treatment prevents new damage to the nervous system and helps quiet MS symptoms.

How they work is similar across both medications, but their molecular structures differ, and those structural differences affect how each one performs, most notably in how quickly it can be infused.

Briumvi’s Approach

Briumvi (ublituximab-xiiy), made by TG Therapeutics and FDA-approved in December 2022, uses a technique called glycoengineering that changes the structure of the antibody in a way that allows it to bind to CD20 more efficiently. This helps the immune system clear targeted B cells more quickly. In the ULTIMATE clinical trials, this approach produced near-complete B cell depletion within 24 hours of the first dose.

This efficient binding is part of what allows Briumvi to work at a lower dose and contributes to its significantly shorter maintenance infusion time.

Ocrevus’s Approach

Ocrevus (ocrelizumab), made by Genentech and FDA-approved in March 2017, is a humanized monoclonal antibody that binds to CD20 on the surface of B cells and depletes them.  This B cell depletion is the mechanism behind Ocrevus’s effectiveness across both relapsing forms of MS and primary progressive MS (PPMS).

What Is Each Treatment Approved For?

The most clinically significant difference between Briumvi (ublituximab-xiiy) and Ocrevus (ocrelizumab) is which forms of MS each one is approved to treat.

Feature	Briumvi	Ocrevus
Active ingredient	Ublituximab-xiiy	Ocrelizumab
Manufacturer	TG Therapeutics	Genentech
FDA approval year	2022	2017
Approved for	Relapsing forms of MS only	Relapsing forms of MS + PPMS
Loading doses	150 mg (Day 1), 450 mg (Day 15)	300 mg × 2, two weeks apart
Maintenance dose	450 mg every 24 weeks	600 mg every 6 months
First infusion time	~4 hours	~2.5 hours
Maintenance infusion time	~1 hour	~3.5 hours
Typical list price	Lower	Higher

Relapsing Forms of MS

Both treatments are FDA-approved for relapsing forms of MS, which include:

• Clinically isolated syndrome (CIS: a first episode of neurological symptoms that may indicate MS)
• Relapsing-remitting MS (RRMS)
• Active secondary progressive MS

These conditions share a pattern of flare-ups followed by partial or full recovery between episodes.

In the ULTIMATE I and II trials, Briumvi (ublituximab-xiiy) reduced the yearly relapse rate by approximately 59% (ULTIMATE I) and 49% (ULTIMATE II) compared to teriflunomide.

In the OPERA I and II trials, Ocrevus (ocrelizumab) reduced relapse rates by 46–47% compared to interferon beta-1a. These numbers aren’t directly comparable, since the trials used different comparison treatments, but both represent meaningful reductions in disease activity.

Primary Progressive MS

Primary progressive MS (PPMS) develops differently from relapsing forms. Rather than episodes and recoveries, PPMS causes a steady worsening of symptoms from the start, with no clear relapses.

Ocrevus (ocrelizumab) was the first treatment ever approved specifically for PPMS, following the ORATORIO trial, which showed slowed disability progression compared to placebo.

If you have PPMS, Ocrevus is currently the only anti-CD20 therapy with an FDA approval for your condition. Briumvi (ublituximab-xiiy) has not been studied in PPMS and is not approved for it. This distinction alone may settle the question for some patients.

Pre-Treatment Screening and Vaccine Planning

Before starting either treatment, hepatitis B screening is required. Both medications can cause the virus to reactivate in people who carry it, even without symptoms.

A vaccine review is also necessary before your first infusion. According to the Ocrevus prescribing information and the Briumvi prescribing information, live vaccines must be completed at least four weeks before starting treatment and should not be given during treatment. Non-live (inactivated) vaccines should be administered at least two weeks before initiating either Ocrevus or Briumvi. 

Your care team will also check for any active infection before each infusion cycle.

Side Effects and Safety

Because both medications work by depleting the same type of immune cells, their safety profiles are highly similar. Knowing what to watch for makes it easier to tell the difference between a normal response and something that needs attention.

Common Side Effects

The most frequently reported side effects include:

• Infusion reactions (like flushing, chills, headache, nausea, or itching) are most common during the first infusion and generally milder with each subsequent dose
• Upper respiratory infections, such as colds, sinus congestion, or sore throat
• Fatigue in the day or two following an infusion
• Headache

To reduce infusion reaction risk, both prescribing informations specify premedication before each infusion: methylprednisolone 100 mg IV (or an equivalent corticosteroid) approximately 30 minutes prior, and an antihistamine approximately 30–60 minutes prior. The Briumvi prescribing information also requires acetaminophen 30–60 minutes before each infusion. Care teams can slow or pause the infusion if symptoms develop during the session.

Serious Risks

The most significant shared safety concern is the risk of serious infections. Because B cell depletion affects how the immune system fights certain infections, patients are more susceptible throughout treatment, not just right after an infusion. Additional serious risks listed in both prescribing labels include:

• Hypogammaglobulinemia: prolonged B cell depletion can reduce immunoglobulin (antibody) levels over time, making it harder for the body to fight infections. Your care team will monitor these levels during treatment.
• Liver injury (hepatotoxicity): report symptoms like unexplained nausea, abdominal pain, yellowing of the skin or eyes, or dark urine to your care team promptly.
• Progressive multifocal leukoencephalopathy (PML): a rare but serious brain infection whose symptoms can overlap with MS. Contact your care team immediately if you notice new or worsening weakness on one side of the body, vision changes, sudden confusion, or problems with coordination or speech.
• Hepatitis B reactivation: a serious risk in carriers, which is why screening is mandatory before starting either medication.
• Herpes infections (Ocrevus-specific): the Ocrevus prescribing information specifically notes an increased rate of oral herpes and herpes zoster (shingles) compared to placebo. Discuss your history of herpes infections with your care team before starting Ocrevus.

Stopping Treatment and Pregnancy

Women who could become pregnant should discuss family planning before starting either medication. Both can affect a developing baby, and reliable contraception is recommended during treatment and for a period after the last dose.

For Ocrevus (ocrelizumab), that period is six months; guidance for Briumvi (ublituximab-xiiy) should be confirmed with your care team. If treatment is stopped, immune function gradually recovers as B cell levels rebuild, but the timeline varies.

Cost, Insurance, and Coverage

Briumvi (ublituximab-xiiy) has generally carried a lower list price than Ocrevus (ocrelizumab), and the shorter infusion time may also reduce facility fees. For a condition requiring treatment every six months over many years, even a moderate cost difference adds up.

Actual out-of-pocket cost depends almost entirely on insurance. Your coverage tier, prior authorization, step therapy rules, and copay structure all play a role. Some plans may require one product over the other.

Acelpa Health’s affiliated pharmacies can help you review your coverage and identify available manufacturer-sponsored and foundation financial assistance programs in accordance with all applicable state, federal, and payor regulations. We believe cost should never stand between a patient and the care they need.

Moving Forward with MS Treatment

For relapsing forms of MS, both of these medications are effective, well-studied options with similar safety profiles.

The factors that usually guide the decision are diagnosis type (Ocrevus is the only option if you have PPMS), followed by infusion time and insurance coverage. It’s about matching the treatment to your medical situation, schedule, and financial reality.

Acelpa Health and its affiliated specialty pharmacies work with MS patients through every stage of treatment, from prior authorization and insurance navigation to medication coordination and ongoing care team communication.

When you’re ready to talk through your options, reach out to the team at Acelpa Health.

Frequently Asked Questions (FAQ): 

What is the main difference between Briumvi and Ocrevus?

The most important clinical difference is that Ocrevus (ocrelizumab) is also approved for primary progressive MS (PPMS), while Briumvi (ublituximab-xiiy) is only approved for relapsing forms. Practically, Briumvi’s maintenance infusions take about one hour compared to roughly three and a half hours for Ocrevus, and Briumvi has generally carried a lower list price.

Which is more effective, Briumvi or Ocrevus?

There are no head-to-head studies directly comparing the two. Both showed strong relapse rate reductions in their trials, but against different comparators, so a direct comparison isn’t possible.

Can I switch from Ocrevus to Briumvi, or vice versa?

Switching is possible but requires careful planning. Your B-cell levels and immune status need to be factored in before making the transition. 

Do Briumvi and Ocrevus require the same safety monitoring?

Broadly, yes. Both require hepatitis B screening before starting, a vaccine review to ensure live vaccines are completed in advance, and ongoing monitoring for infections. Both carry a small risk of PML, a rare brain infection, so any new neurological symptoms should be reported to your care team promptly.

Is Briumvi cheaper than Ocrevus?

Briumvi has generally had a lower list price ($14,198.58 (1 6mL vial – 150mg/6mL)) versus Ocrevus ( $26,057.15 (1 10mL vial – 30mg/mL)). Briumvi also typically has shorter infusion times, which may reduce facility costs per appointment. Actual out-of-pocket cost depends heavily on your insurance plan and coverage situation. 

Can Briumvi or Ocrevus be used during pregnancy?

Neither is recommended during pregnancy. Contraception is advised during treatment and for a period after the last dose: six months for Ocrevus, with Briumvi guidance to be confirmed with your care team. Discuss family planning with your neurologist in advance, as pausing or switching treatment requires careful timing.