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    Rituxan or Ocrevus

    I believe I'm going to ask my Neurologist about switching treatments. I'm thinking Rituxan or Ocrevus. I'm just not sure about how similar they are or about approvals. It seems Ocrevus would be easier to get approved through insurance. Rituxan is recommended for the type of inflammatory arthritis I am diagnosed with. Any information would be appreciated.

    #2
    Hi KatW,

    Ocrevus is specifically approved for MS. It is a humanized anti-CD20 monoclonal antibody (monoclonal antibody = made in a laboratory). It targets CD20 marker on B lymphocytes and is an immunosuppressive drug.

    Rituxan (Rituximab) is FDA approved for Rheumatoid Arthritis and used "off label" for MS. Rituxan is a chimeric anti-CD20 monoclonal antibody. It is a chemotherapy drug.

    Ocrevus binds to a different but overlapping region on B cells than Rituxan does. Since Ocrevus is derived mostly from human antibodies, it induces less of an immune response to foreign antigens. Ocrevus is thought to bind more to CD20 than Rituxan. For these reasons, it is thought to have a more favorable benefit to risk profile in MS.

    There are no published studies with Ocrevus for RA. So there's no scientific data to determine how well it may or may not work for that condition.

    There are also no published studies that directly compare Ocrevus and Rituxan in treating MS.

    Ocrevus is associated with fewer infusion-related reactions because it is a humanized antibody. Studies of Ocrevus have revealed an increased risk of breast cancer, while the limited studies of Rituxan in MS did not reveal a similar risk.

    Insurance companies may not cover "off-label" treatments used for MS, so depending on your insurance, you may need it prescribed for your RA.

    Rituxan is also used with Methotrexate in the treatment of RA. The dosing schedule may be different than for MS. I believe it may be more frequent, but that is something to ask your rheumatologist. Rituxan is usually prescribed for RA if you haven't responded well to other treatments. (This is also sometimes the case with MS disease modifying therapies.)

    Your rheumatologist might have more insight on that, and if feels this medication is warranted for you, can make a case to persuade your insurance company to cover it if there is a problem. My neurologist made a case for me when he prescribed a different drug (also used "off-label" for MS).

    Your neurologist would most likely have your rheumatologist prescribe the medication for you if chosen to treat your RA as well. I hope they will work together to determine the best treatment and who should prescribe it for you.

    Best of luck and please keep us updated.
    Last edited by KoKo; 03-08-2020, 09:08 PM. Reason: op request
    Kimba

    “When you change the way you look at things, the things you look at change.” ― Max Planck

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      #3
      Hi KatW,

      Additional information about prescribing Rituxan for Rheumatoid Arthritis:

      Riituximab (Rituxan) is approved by
      The Food and Drug Administration in combination with Methotrexate for the treatment of Rheumatoid Arthritis (RA) in patients with moderate to severe rheumatoid arthritis who have had an inadequate response to one or more TNF antagonist therapies.

      It is only approved as a second line therapy. This classification refers to a drug that may only be prescribed when other FDA-approved treatments fail or are not tolerated well by a patient. The MS drug Lemtrada has been given the same classification by the FDA. It is not prescribed before other appoved treatments fail.

      In another thread, you mentioned you are on Plaquenil, which is not a TNF therapy.

      The drugs in this class include Remicade (infliximab), Enbrel (etanercept), Humira (adalimumab), Cimzia (certolizumab pegol) and Simponi (golimumab).

      While there are some cases where patients have been approved for a second line therapy before failing others first, the odds may not be in your favor.

      So your neurologist would more likely need prescribe it for your MS. Methotrexate would not be prescribed in combination with it, though.

      For RA, it is typically prescribed every six months, up to.every four months if needed. For MS, it's prescribed every six months. The dose is the same for both conditions, 1,000 mg.

      Worth a discussion with your doctors if you'd like to consider taking this drug.

      Best of luck!.
      Kimba

      “When you change the way you look at things, the things you look at change.” ― Max Planck

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        #4
        Rituximab was never approved for MS because the patent was running out and wasn't worth the huge clinical trials investment.

        Despite the release of Ocrelizumab, I remain on rituximab and have little reason to change. It's subdued previously active MS that 6 other medications could not. Rituximab has been on the market for many years and we have a lot of knowledge about its safety profile.

        Ocrelizumab, while similar, has already shown an increase in cancer rates unseen in rituximab. Why this is happening is not clearly understood. For me, the biggest reason to select Ocrelizumab over rituximab is the much lower rate of developing neutralizing antibodies. The lower rate is attributed to Ocrelizumab being humanized versus the chimeric nature of rituximab.

        Dosing is generally the same, but there's no set protocol for rituximab (since it's off-label). I now get 500 mg every 6 months which is fairly common in the MS/Rituximab community.

        Many insurance companies readily approve rituximab because it's considerably cheaper than Ocrelizumab. Recently more insurance companies are even moving patients from rituximab to Truxima, a biosimilar medication.

        I wish you well...

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