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The Case for Less Frequent Infusions

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    The Case for Less Frequent Infusions

    Hi MGM,

    The data you seek is here:

    Long-term safety and efficacy of ocrelizumab in patients with relapsing-remitting multiple sclerosis: Week 144 results of a Phase II, randomised, multicentre trial

    I strongly urge anyone wanting this info to save it because, IMO, this pdf will get pulled from the internet shortly. I’d be willing to bet on it; I hope I'm wrong but why chance it when you download it now?

    Please find Figure 4 and enlarge it so you can read it. It is the bar chart which is titled “Relapse Activity Weeks 0-144”

    The first set of bars is for placebo. The second set of bars is for OCR (Ocrelizumab 600mg). Do you see there are 4 infusions of OCR, the last at 72-96 weeks? Below that figure it says “Treatment-free”in green print. The bar graph shows that after 4 courses of OCR relapse activity did not pick up even after OCR treatment stopped.

    Question… w/o MS activity why continue taking OCR after 4 courses and risk serious infections or possibly, even cancer?

    Question… why take more of a medicine required to contain MS?

    Question… why spend a lot of money (insurance or your own) on medicine doing no more than if you were not taking it after 4 courses?

    Question… why go sit for a 5 hour infusion, needlessly?

    The real question… why keep trying to kill something already dead (CD20 cells), why not test to see if/when those problem cells reconstitute and THEN, if they do, kill them with another course of OCR? The problem is that OCR does not only kill CD20 but it also diminishes other mainstays of the immune system, so why overdo it and risk creating serious problems a more properly functioning immune system would have taken care of?

    BTW, since CD 20 cells cannot be tested, CD 19 is reported on labs. Essentially, the two have the same value. Just know that CD19 is what will be on your lab report. CD19 value is used in place of CD20.

    Thank you Myoak. I have it saved and will discuss with my neuro on my next visit.
    God Bless Us All


      Why keep depleting something if it isn't there? Is it prudent to put yourself at unwarranted health risk AND waste a bunch of money?

      Anti-CD20 Cell Therapies in Multiple Sclerosis-A Fixed Dosing Schedule for Ocrelizumab is Overkill.

      Quote, "there is no scientific validity to giving the drug when CD20 cells are nonexistent in the periphery at counts below 20cells/μL. Any effective treatment strategy that aims to minimize unnecessary patient exposure to the drug helps with patient safety and allows for significant cost savings to the patient and third-party payers.

      Therefore, the following recommendations are suggested.

      (1) If the disease activity stabilizes both clinically and from a
      radiological perspective, less frequent retreatment might be
      sufficient to prevent relapses,
      although the correlation between
      clinical/radiological criteria to disease activity is not a linear
      relationship and therefore must be individualized based on
      monthly CD20 cell counts by monitoring CD19 cells.

      (2) Alternatively, CD20 cell counts must be monitored monthly
      on a routine basis irrespective of clinical or radiological status
      and reinfusion of the drug carried out after the cell population
      rebounds to ≥20 cells/μL;
      this holds true also for patients who
      develop ADAs that can neutralize OCR activity in which case
      the CD19 cell count would repopulate." End Quote. My highlights.


        I spoke to a MS Specialist about this some time ago. He told me he use to test before administering rituximab, but patients would sometimes relapse between tests. So he changed up the protocol and infuses every 6 months.

        It's one thing to want something, but unless a physician is willing to go along it isn't going to happen.

        I've been working with my neurologist on reducing the overall amount of medication that I receive. Overtime, we have reduced the amount of solumedrol from 500 ml to 50 ml and the amount of rituximab from 1000 ml to 500 ml. The dosing schedule remains 6 months, but that might be an exercise for next infusion or next year.

        It took me 9 months and 3 outside consults with MS Specialists to get him to prescribe rituximab so change doesn't come easy or fast.