Ocrelizumab versus Rituximab (Rituxan)

Ocrelizumab versus Rituximab (Rituxan)

I decided to go a little honest about our pharmaceutical world of MS. There has been so much press and promise over this new drug coming out for multiple sclerosis. Put Ocrelizumab in your web search and you’ll get article after article about the promise of this new drug.


Rituximab is Ocrelizumab

The patent on Rituximab expired in the US in 2015. Basically when they were doing the clinical trials with multiple sclerosis by the time they were up to phase III the patent would have expired.

No patent=no profit.

So Genetech started inventing a new drug. The biggest difference is that Rituximab is a chimeric antibody, a genetically engineered antibody. Ocrelizumab is a humanized antibody, antibodies from non-human species, whose protein sequences have been modified to be similar to those found naturally in humans. Otherwise Ocrelizumab is basically the child to Rituximab. Being that Ocrelizumab is humanized antibody, the hope was improved safety and reduced  infusion reactions. What actually happened is it turned out that Ocrelizumab was LESS safe. In 2010 trials on Ocrelizumab for Lupus and Rheumatoid Arthritis had to be abandoned because of an unacceptable number of serious and sometimes fatal infections. Ocrelizumab is almost identical to that of Rituximab (except for the way the antibodies are created, chimeric versus humanized) which has been used for decades to treat cancers of the blood and for 7-8 years off label basis for treating multiple sclerosis. Rituximab is pretty safe, a good drug therapy, and has a large data history and experience.  It isn’t cleared for multiple sclerosis use because of pharmaceutical profit lines not seeing it to the phase III clinical trial. Therefore some insurance  companies will DENY the use of the safer Rituximab but approve the still to see Ocrelizumab when it actually is released. THEY ARE BASICALLY THE SAME DRUG. However FDA can’t  approve Rituximab for multiple sclerosis without  phase III. No phase III because of $$$$$$$$$$. We the patients are left with the choice what do we do, what can we do?

I was denied by my insurance for Rituximab and denied 2 appeals and even took the appeal to the state level and was denied (I have state insurance). I finally got into the patient assistance program from Genetech and am able to receive Rituximab (pays to be poor). However this was also because Ocrelizumab was not out yet. It was supposed to be released January 2017 but was once again push back.  There is a very good possible I may have to go to the Ocrelizumab which my insurance would pick up, because it was FDA approved for multiple sclerosis, but if prefer to stay with Rituximab.  I’d rather be on a drug that there is a well known history on, not one pulled from the shelf many times. Anyway just wanted the truth out there, I’m tired of seeing these promised articles everywhere when this drug really isn’t “NEW”.

26 thoughts on “Ocrelizumab versus Rituximab (Rituxan)

  1. United Health Care denied my infusion. They approved the first one back in August of 2016, but denied this past one in Feb of 2017. Its frustrating. I do all the right things (eat clean, workout 4-5 times a week – lifting, don’t smoke and keep alcohol to a minimum) and can’t get the treatment I need.

    1. Got denied covered now through the patient assistance program to get Rituxan and now emblem health denied infusion. Even though they aren’t paying for medicine they denied that Rituxan isn’t medically necessary. Blogged on that BS too. So frustrating

  2. I have been on Rituxan for almost 3 years, also moved/moving from RR to SP MS. My Dr. and I both agree that it is helping, progression seems to have slowed. Even without a cure, I guess one way to attack the problem is to kill the attackers which makes sense to me.

    My insurer is Kaiser SoCal and Rituxan is approved for off label use for MS. My Dr. says its the same thing as Ocre. and knows the Drug co. game and that Rituxan has a safe history. Maybe it will also help fend off skin cancer since I am one of those old souls who had a lot of sun exposure before sunscreen was even invented!

    Good Luck and keep fighting!

    1. i have been on rituxan since last year still waiting on miraculus but my insurance is paying for it i had a couple pf weeks i thought things were starting to get better then ms said ha ha i fooled you but all in all i am satisfied with treatment just wondering if insurance will make me go to the fda approved drug but i hope i can stay on what i am on

      1. I haven’t had any miracles with Rituxan but I’d prefer to stay on it as well but since my insurance was being difficult I decided to take the other road with Ocrelizumab. We’ll see as the story goes. I can’t lie, I do have my concerns.
        I really don’t think you’ll have any problems staying on Rituxan if insurance already covers it.

  3. I had to have 6 Rituximab infusions every 2 months over the course of a year as part of my post HSCT treatment and I found the cost to be amazingly high as Australian Medicare wouldn’t cover it because it wasn’t recognised as an ‘ approved’ treatment for MS in this country ! Now I know what the real story was . Anyway I did end up having the Rituximab at great expense to myself and my treatment is now complete , my walking and balance have returned to me , I now have only 2 lesions compared to the 12 I had prior to HSCT and Rituximab and my EDSS has gone from 4.0-4.5 pre-HSCT in 2015 to 1.0-1.5 post HSCT 2017 ? Thank you for this well written and informative article .

    1. In the US they are dumb sometimes. Rituxan wasn’t approved by my insurance which cost roughly $32,000 a year because it is technically NOT approved for MS but they’ll approve the Ocrelizumab for $65,000 a year that was approved. The same basic drug. Then the question of higher health care prices falls to the patients. Not a very fair system.
      So great it worked well for you. That’s what it’s supposed to do. Hope you continue to feel better.

  4. I just came off Tecfidera after 3 years and lymphocytes count going down to 1.2. I have been off Tecfier for 90 days, I would like to go on Ocrelizamab, but after reading
    Several articles, it seems retuximab could be safer. I have also been Diagnosed with Myasthenia Gravis and had an excaserbation in 2013. Plus my arthritis is quite painful everyday. I know Rituximab would address all 3 problems, will Ocrelizamab do the same? I can get Rituximab at the VA hospital and Ocrelizamab through my private insurance. Any advice would be appreciated

    1. I can tell you rituxan has been around for over 15 years and has a lot more statistical data which I think makes it safer. As far as working for all three, I don’t know I’m certainly not a doctor. I can only say what has worked for me with my ms. I’d stay on rituxan IF my insurance approved it that’s the ONLY reason I’m changing to Ocrelizamab. I hope it helps.

  5. I have advanced MS, that is a type that doesn’t fit into one of the named types. After being stable with NEDA for 6 years, I had an exacerbation that began in October 2016 and is still ongoing. I am scheduled to get Rituxan next week and then again in two weeks. My insurance company initially denied the Rituxan because it is not FDA approved for the treatment of MS, but then approved it after a Peer to Peer review. I have had a hard time getting an estimate of the cost, though.

    1. Ritual costs roughly $9,088 per treatment. Even at the peer to peer review I was denied. I got it through the patient assistance grant. I blogged about why I need to go to Ocrelizumab https://multipleexperiences.org/2017/03/30/7-reasons-why-i-decided-to-put-ocrelizumab-ocrevus-back-on-the-table/ but I liked the safety and history of safety of Rituxan. However I have still progressed on the secondary side with it, unfortunately so I won’t make any false representation. I hope you find something that helps. Other than being a long infusion, I had no side effects

  6. Just some follow up on the history of the original post. Should read these 2 articles if you haven’t. I would even print out and share with my Dr./insurance provider if I was denied coverage.

    The shameful story of Rituximab in Multiple Sclerosis https://neuroimmunology.wordpress.com/2011/03/27/the-shameful-story-of-rituximab-in-multiple-sclerosis/

    Rituximab vs Ocrelizumab in multiple sclerosis

    1. Thanks where we wish we could do more, this went up to the state level and they still denied. We can’t fight after that, out of appeals. Some go through I just got unlucky with the doctors on the appeal board. I will check them out though.

  7. Where have you been all my life?!?!? Sorry trying to be cute, but NOT sorry, because I wish like hell I would have seen this blog in August when I was having to stop taking Tysabri. It sounds like you’ve got quite a full plate, so I wont add more to it by making you read and answer comments. Last thing, I am glad to have ‘met’ you. On the surface we have ALOT in common!

    1. I must say I kick around whether I wanna continue to blog or not. And just today I decided I think I’ve had enough. Then someone like you comments and I realize why I’ve always bloged. I just want people to know they’re not alone. So I truly thank you

  8. Update, been on Rituxan for 8 years now and just hit 65 years of life! When I was originally diagnosed with MS, life expectancy was reduced by 5 to 15 years (not so today) which actually helped me to appreciate every day more. Still mobile, should use my cane all the time now, but just stubborn and don’t. Will continue Rituxan therapy. If I was younger or had an extra $150,000 might do the harvested stem cell/ immune system reboot that seems to be working for some, now available in the U.S. and in clinical trials.
    But though I would let you all know about my immune system response to illness. I did catch a common cold a few years ago right after an infusion, and I did mount an in immune system response, just took about 10 days instead of the usual 1 or 2 days to get over that cold, no fever so wasn’t the flu.
    This past summer, June of 2022, I got Covid while on camping trip in Alaska. The 1 time we forgot to wear our masks was at an aquarium in Seward and a cruise ship docked and flooded the building with people. Both my wife and I had the Pfizer shots and boosters (4) at the time which I know based on blood tests that I still lacked any surmountable immunity. My wife and I both started feeling sick within 48 hours. We did RAT tests and I was positive for Covid and my wife was negative. Coincidentally, she caught the flu. We immediately went to a clinic where I again tested positive, and requested Paxlovid treatment which I had already researched. Doctor wrote me a prescription I started that day… I was sick for 2 days, then voila, I was feeling better day 3. After the 5 day treatment, I tested negative, felt better and cough was gone around day 7. Just wanted you to know that to maybe set aside some fear of getting Covid while immunosuppressed, but note that the cure was not by my own T-cell response, but the Paxlovid inhibiting virus reproduction. Nice knowing that there is a drug out there that can help a susceptible person from getting really sick or requiring hospitalization from Covid.
    Also note that if you are on/considering Rituxan, studies have shown that 500ml treatment works as well as 1000ml, requiring much less time for an infusion. I have personally been able to verify this with my doctor through several blood tests during treatment.
    Lastly, I have read a lot about the info I presented here, but don’t have references at hand. However, I would be happy to find/provide those if requested, or just Google and if you can’t find them, I can help.
    Good luck and have a great day!

    1. Thank you for all that. I have been taking Rituxan for a while as well. I prefer it to Ocrevus although I’ve done both. I was changed to Kesimpta in September 2021.
      I rarely get sick but I did with Kesimpta . I wrote many blogs about it. I did get Covid to start the year off but they didn’t give me any medication to help me even with my weakened immune system. I ended up with a pneumonia a month later and that was awful.
      Thankfully I am doing better than I was. I am back on Rituxan just did my second infusion for the year.

  9. Even though we may disappear for a while from posting, if 1 person can find our posts helpful, I believe it is worth the effort. I also occasionally attend support group meetings and realize that sharing is so important and beneficial to those newly diagnosed and needing our help/insight. There are usually many more readers that do not post, though it may seem like a vacuum out there in the ether. I do appreciate your blog and knowing I have a kindred soul out there!
    I have posted as both Dingo and Scotty B on this blog.

    1. I appreciate this and appreciate your support. I really do write to help. I’ve been on the MS road for a long time. I’ve had so many experiences. I share so no one feels alone. ??

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