Understanding Ocrevus and Prednisone in MS Treatment
Multiple Sclerosis (MS) management often involves a dual approach: long-term disease modification and short-term relapse management. Ocrevus (ocrelizumab) is a leading disease-modifying therapy (DMT), while prednisone is a corticosteroid commonly used to treat acute relapses. Understanding their distinct roles is crucial for patients navigating their treatment journey.
What is Ocrevus (Ocrelizumab)?
Ocrevus is a monoclonal antibody administered via intravenous infusion every six months [1.3.3]. Its primary function is to target and deplete specific immune cells called CD20-positive B-cells [1.6.4, 1.6.5]. In MS, these B-cells mistakenly attack the myelin sheath that protects nerve cells, leading to inflammation and damage [1.6.2]. By reducing these B-cells, Ocrevus helps to decrease the frequency of relapses and slow the progression of disability in both relapsing-remitting MS (RRMS) and primary progressive MS (PPMS) [1.7.4].
What is Prednisone?
Prednisone is a synthetic corticosteroid, a powerful anti-inflammatory and immunosuppressive medication [1.5.1, 1.5.4]. It's a prodrug, meaning the liver must convert it into its active form, prednisolone [1.5.3]. When an MS relapse occurs—characterized by a flare-up of symptoms due to new inflammation in the central nervous system—doctors often prescribe a high-dose, short course of corticosteroids like prednisone or intravenous methylprednisolone to quickly reduce inflammation and shorten the duration of the relapse [1.7.5].
The Core Issue: Combining Immunosuppressants
The central question of whether you can take prednisone while on Ocrevus hinges on their combined effect on the immune system. Both medications suppress immune function. Ocrevus does this in a targeted, long-term manner by depleting B-cells, while prednisone provides a broad, short-term suppression of overall immune activity [1.4.1].
Using them together significantly increases the risk of immunosuppression, making the body more vulnerable to infections [1.8.1, 1.8.2]. This is the primary concern for neurologists. The risk is particularly heightened when using high or long-term doses of corticosteroids [1.4.3]. Signs of infection to watch for include fever, chills, sore throat, cough, body sores, or pain during urination [1.8.1].
Despite this risk, authorities acknowledge that using corticosteroids for the symptomatic treatment of an MS relapse is a necessary exception [1.2.4]. A doctor will carefully weigh the severity of the relapse against the increased infection risk before prescribing prednisone [1.2.1].
Corticosteroids as Premedication for Ocrevus Infusions
It is standard procedure to administer a corticosteroid before an Ocrevus infusion. Patients typically receive 100 mg of intravenous methylprednisolone (or an equivalent) about 30 minutes before each infusion [1.3.1, 1.10.1]. This is not for treating an MS relapse but to reduce the frequency and severity of infusion-related reactions, which are common with Ocrevus [1.3.5]. This is a controlled, single dose and is a standard part of the Ocrevus administration protocol, distinct from taking a multi-day course of oral prednisone for a relapse [1.10.2].
Ocrevus vs. Prednisone: A Comparison
To clarify their roles, here is a comparison table:
| Feature | Ocrevus (Ocrelizumab) | Prednisone |
|---|---|---|
| Primary Use in MS | Long-term disease modification; reduces relapse frequency and slows disability progression [1.7.4]. | Short-term treatment of acute MS relapses to reduce inflammation [1.7.5]. |
| Mechanism | Targets and depletes CD20-positive B-cells, a specific part of the immune system [1.6.4]. | Broadly suppresses the immune system and has potent anti-inflammatory effects [1.5.1]. |
| Administration | Intravenous infusion every 6 months [1.3.3]. | Typically an oral tablet taken in a high-dose course over several days [1.5.4, 1.7.5]. |
| Treatment Duration | Long-term, ongoing therapy. | Short-term, as needed for relapses. |
| Main Risk When Combined | Additive immunosuppressive effect, increasing the risk of serious infections [1.8.2]. | Additive immunosuppressive effect, increasing the risk of serious infections [1.8.1]. |
Navigating Treatment Decisions with Your Doctor
If you are on Ocrevus and experience what you believe is a relapse, the first step is to contact your neurologist immediately. They will assess your symptoms to confirm if it is a true relapse. If treatment is deemed necessary, your doctor may decide that the benefits of a short course of prednisone outweigh the risks [1.2.1].
During this time, your doctor will likely monitor you more closely for any signs of infection [1.4.4]. It is crucial to inform your healthcare team about any new symptoms you experience, especially those suggesting an infection [1.8.1]. If an active infection is present, your doctor may need to delay your next Ocrevus infusion until the infection has resolved [1.10.5].
Conclusion
In conclusion, while taking prednisone while on Ocrevus is not contraindicated, it is a decision that requires careful medical consideration. The combination is typically reserved for managing significant MS relapses and is done with the knowledge that it increases the risk of infection due to compounded immunosuppression. The short-term, low-dose corticosteroid administered as a premedication for Ocrevus infusions is a standard and safe practice designed to prevent infusion reactions. For relapse management, open communication with your neurologist is essential to ensure a safe and effective treatment plan tailored to your individual health status.
For more information on Ocrevus, you can visit the official manufacturer's website: OCREVUS® (ocrelizumab) [1.3.2].
