What you need to know about Ocrevus^® for MS

Getting a recommendation for Ocrevus^® (ocrelizumab) for multiple sclerosis (MS) can bring up a lot of questions. What exactly does it do? What will treatment days look like? What should you realistically expect? You’re not alone in asking all of this, and having clear answers makes it easier to feel ready.

Here’s what matters: how Ocrevus^® works, who it’s approved for, and what to expect from infusion day and beyond. And if you’re looking for a specialty pharmacy that works alongside your neurology team, you’re in the right place.

What is Ocrevus^®?

Ocrevus^® (ocrelizumab) is a biologic medication, a lab-made protein designed to target a specific part of the immune system. The FDA approved it in March 2017, making it the first therapy ever approved specifically for primary progressive MS (PPMS). People with PPMS previously had very limited treatment options, so this was a significant shift.

Ocrevus^® is given by IV infusion on a six-month schedule. A subcutaneous (under-the-skin) alternative called Ocrevus Zunovo^® (ocrelizumab) became available in 2024 for eligible patients, offering a shorter administration time. Your care team can help determine which formulation fits your situation.

Acelpa Health and its affiliated specialty pharmacies, including California Specialty Pharmacy (CSP), ContinuumRx (CRx), Hawaii Specialty Pharmacy (HSP), Continuum Health (CH), and Integrated Care Systems (ICS), are here to help with the practical side of MS treatment. We specialize in complex autoimmune and neurological conditions, including MS, helping with everything from coordinating prior authorization and answering insurance questions to keeping your neurology team in the loop.

How does Ocrevus^® work for MS?

To understand how Ocrevus^® (ocrelizumab) works, it helps to know what’s going wrong in the immune system during MS.

Ocrevus^® targets a protein called CD20, found on the surface of certain B cells, a type of white blood cell central to MS disease activity. When the medication binds to CD20, it signals the immune system to clear those cells.

The role of B cells in MS

With multiple sclerosis (MS), the immune system gets confused and starts attacking the body’s own tissue. Specifically, it targets myelin, the protective coating around nerve fibers.

B cells are one of the main immune cells involved in this process, and researchers believe they contribute to the inflammation that damages nerve tissue. They produce antibodies that target myelin, trigger inflammation, and activate other immune cells that damage nerve tissue.

Over time, this leads to lesions (areas of damage visible on MRI scans), relapses, and gradual nerve damage.

What does B cell depletion do?

By reducing CD20-positive B cells, Ocrevus^® (ocrelizumab) can dampen this inflammatory cycle.

The OPERA I and II clinical trials showed that patients with relapsing forms of MS experienced approximately 46-47% fewer relapses per year compared to those on an older injectable treatment.

The ORATORIO trial showed that patients with PPMS had around 24% slower disability progression compared to placebo. The medication does not reverse existing nerve damage, but it works to slow the accumulation of new damage going forward.

How long do the effects last?

B cells gradually return to the bloodstream in the months after each treatment. This is why you come back every six months for another infusion, to keep the effect going.

There’s no fixed stopping point built into Ocrevus^® treatment, and some patients have continued treatment for up to seven years in clinical trial extensions. Your care team will check in at each visit to make sure the treatment is still working well for you.

Who is Ocrevus^® a good fit for?

Ocrevus^® (ocrelizumab) is approved for adults with relapsing forms of MS, which include:

• Relapsing-remitting multiple sclerosis (RRMS)
• Clinically isolated syndrome (CIS)
• Active secondary progressive MS (SPMS, where relapses or new MRI activity still occur alongside gradual worsening)

It is also approved for primary progressive MS (PPMS), where symptoms worsen gradually without distinct relapses. The National Multiple Sclerosis Society gives more details on how these MS types differ.

That said, Ocrevus^® isn’t right for everyone. If you have an active hepatitis B infection, Ocrevus^® isn’t an option right now because it can cause that infection to flare up. Even patients who are hepatitis B (HBV) carriers or have had prior HBV exposure should consult a specialist before starting. Any other serious active infection needs to be treated and cleared first as well. If you’re pregnant or thinking about becoming pregnant, talk with your care team before starting, since the effects of Ocrevus^® on a developing baby aren’t yet fully understood. You should use birth control (contraception) during treatment with Ocrevus^® and for 6 months after your last infusion of Ocrevus^®.

Your neurologist will look at your full picture before recommending Ocrevus^®: how active your MS has been, what treatments you’ve tried before, your vaccination and infection history, and any other medications you take.

What to expect during treatment

Starting Ocrevus^® (ocrelizumab) involves some preparation before your first infusion and a straightforward schedule going forward. Getting ready in advance can help make the process smoother.

Screening and preparation

Before your first infusion, your care team will complete the required screening and preparations to determine if you can safely start treatment. Here’s what to expect:

• Hepatitis B testing. Ocrevus^® can reactivate hepatitis B in carriers, even in people with no prior symptoms. Screening is required before starting.
• Vaccine review. Live vaccines, including MMR, varicella, and the nasal spray flu vaccine, must be completed at least four weeks before the first infusion. Non-live vaccines should be given at least two weeks prior. Once treatment begins, live vaccines are not safe.
• Checking for active infections. Any active infection should be treated and resolved before starting.
• Baseline blood tests. These establish reference points for monitoring, typically including a complete blood count and hepatitis B markers.

Pre-medications given about 30 minutes before each infusion, typically a corticosteroid (a steroid medication) and an antihistamine, help reduce the chance of a reaction. Eating a light meal and staying hydrated beforehand also helps.

The infusion schedule

The first treatment course consists of two infusions given two weeks apart, each delivering 300 mg of medication over about 2.5 hours. After completing the initial course, a single 600 mg infusion is given every six months over about 3.5 hours.

Your first infusion will be run slowly so your care team can keep a close eye on how you’re responding. If you tolerate the first couple of infusions, later infusions can often be finished more quickly. All in, including the monitoring time before and after, your first visit will run four to five hours.

What to expect on infusion day

Here are some tips for your infusion:

1. Arrive hydrated and having eaten a light meal.
2. Comfortable clothing with easy access to the arm for IV placement helps.
3. Bring something to read or watch, since infusions take several hours.

Nursing staff will check vital signs regularly throughout, particularly during the first hour when reactions are most likely. After the infusion, the care team monitors you for at least an hour before discharge. Mild fatigue in the day or two that follow is common, so planning a lighter schedule for 24 to 48 hours helps.

Side effects and safety

Because Ocrevus^® (ocrelizumab) works on the immune system, it’s worth knowing what side effects can happen and when to reach out to your care team.

The team at Acelpa Health’s affiliated pharmacies works closely with prescribing providers to support you through infusion therapy and help with any concerns that come up along the way.

Infusion reactions

Side effects that happen during or right after the IV treatment are the most common concern with Ocrevus^® (ocrelizumab).

These can include:

• Flushing
• Itching
• Rash
• Throat irritation
• Headache
• Fever
• Fatigue
• Shortness of breath
• Nausea
• Rapid heart rate
• Changes in blood pressure.

In clinical trials, a large number of people experienced some kind of reaction during an infusion, with the highest rates happening during the first one. These reactions can happen up to 24 hours after the infusion. Pre-medication may help reduce the risk of these reactions.

If a reaction does happen, your care team at Acelpa Health’s affiliated pharmacies can slow or pause the infusion and give additional medications, if ordered by your healthcare provider, to help. Most people find that reactions become less of an issue with each subsequent infusion.

Infection risks

Because Ocrevus^® reduces B cells, your immune system may not fight off certain infections as easily. This lasts throughout your treatment, not just right after each infusion. Upper respiratory infections are the most common, but more serious infections can also occur, especially when Ocrevus^® is used alongside other medications that affect immune function.

Don’t wait for your next scheduled visit if you develop a fever, chills, a persistent cough, or anything that feels off. Reach out to your care team promptly. Staying current on vaccinations recommended by your health care provider is also important throughout treatment.

Rare but serious risks

Progressive multifocal leukoencephalopathy (PML), a rare brain infection, has been reported in patients receiving Ocrevus^®. While uncommon, it can be serious. This is why it’s important to report any new neurological symptoms immediately, including confusion, weakness on one side of the body, vision changes, or difficulty speaking.

Hepatitis B reactivation is another serious risk for carriers, which is why screening before starting is required. Cancer (malignancy) is also listed in Ocrevus^®‘s prescribing information based on clinical trial findings. Your care team will review your individual risk profile before and throughout treatment.

What Ocrevus^® can (and cannot) do

Ocrevus^® (ocrelizumab) is not a cure for MS, and it does not reverse nerve damage that has already occurred. What it can do is possibly help slow the rate at which new damage accumulates, which matters for long-term outcomes.

For people with relapsing forms of MS, the goal is fewer relapses and fewer new lesions. For people with PPMS, the goal is slower disability progression. Both are meaningful, even if the day-to-day benefit may not feel obvious at first. Because Ocrevus^® is primarily preventive, benefits may take months to become apparent and may best be measured over years of consistent treatment.

One question that comes up often: is Ocrevus ^®chemotherapy? It’s not. It’s a biologic medication that targets specific immune cells involved in MS inflammation. That’s very different from how chemotherapy works, even though both can be given by IV.

Moving forward with Ocrevus^® for MS

Starting a new MS treatment is a big step, and it’s completely normal to have questions along the way. The more you know about what to expect and when to reach out, the easier it gets to settle into a routine that works for you.

If you have questions about starting Ocrevus^® or want help coordinating your infusion schedule, the team at Acelpa Health’s affiliated pharmacies is ready to help.

Frequently Asked Questions (FAQ):

What does Ocrevus^® do for MS?

Ocrevus^® (ocrelizumab) reduces the B cells that drive inflammation and nerve damage in MS. For relapsing forms of MS, this means fewer relapses and less new lesion activity. For primary progressive MS (PPMS), the goal shifts to slowing the gradual worsening of disability. Ocrevus^® won’t reverse damage that’s already happened, but it works to slow down what happens next.

Who is Ocrevus^® approved for?

Ocrevus^® is FDA-approved for adults with relapsing forms of MS, including RRMS, CIS, and active SPMS, and for PPMS. That said, it’s not right for everyone. Your neurologist will take a close look at your health history, how active your MS has been, your vaccination status, and any other medications you take before recommending it.

How is Ocrevus^® different from chemotherapy?

A lot of people wonder about this, and it’s a fair question. Ocrevus^® is not chemotherapy. It’s a biologic medication, a lab-made protein that targets specific immune cells involved in MS inflammation. Chemotherapy works very differently, broadly targeting rapidly dividing cells throughout the body. Both can be given by IV, but that’s where the similarity ends.

What are the most common side effects of Ocrevus^®?

The most common concern is side effects that happen during or right after the IV treatment. In clinical trials, about 34-40% of people experienced some kind of reaction, most often during the first infusion. These can include flushing, itching, headache, fever, and fatigue. Pre-medication helps reduce these reactions significantly. Increased infection risk throughout treatment is also something to stay aware of between infusions.

How long do you stay on Ocrevus^®?

There’s no set time limit. Many people stay on Ocrevus^® for years as long as it’s working and the benefits outweigh the risks. Your care team will review how things are going at each visit and adjust the plan if needed. It’s a decision you make together, based on how your body is responding.

Can Ocrevus^® be given as an injection instead of an infusion?

Yes, there’s now an option for that. Ocrevus Zunovo^® (ocrelizumab) is a subcutaneous (under-the-skin) formulation approved in 2024, and it offers a shorter administration time of about 10 minutes compared to the standard IV infusion of more than 2 hours. Not everyone is eligible, but it’s worth asking your care team whether it might be a good fit for you.