Q&A 70: Stay on ocrelizumab or switch to alemtuzumab or AHSCT?

My neurologist tells me that alemtuzumab has never shown to be better than ocrelizumab when it comes to PIRA, and there is no reason to switch.

Case study

I'm a 31-year-old man with multiple sclerosis. I was diagnosed with two relapses within 6 months in 2023. I have six brain and two spinal lesions, but gratefully, I have minimal disability due to my relapses (EDSS 3), and I can live a near-normal life.

I have been on Ocrelizumab since December 2023 as my first DMT, and so far, I have had no relapses and no visible progression. However, uncertainty about the future is difficult to deal with.

After following your content, I have been questioning if I should push my neurologist to give me a stronger DMT, especially considering I am still relatively young and at an "early stage". AHSCT is not offered in my country by the health service, but I could go the private route or try to push for Alemtuzumab.

My neurologist tells me that alemtuzumab has never shown to be better than ocrelizumab when it comes to PIRA, and there is no reason to switch. In her experience, Ocrelizumab works just as well, with lower risks. I would like to know your opinion.

My questions are:

Is it sensible to switch to alemtuzumab even if ocrelizumab is working as expected in the early stage?

Could I expect less future disability in the long term if I switch? Am I "losing time" being on Ocrelizumab?

Should I consider going to private AHSCT? (Even though the financial effort is enormous)

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Prof G’s answer

Q1: “My neurologist tells me that alemtuzumab has never shown to be better than ocrelizumab when it comes to PIRA, and there is no reason to switch. In her experience, Ocrelizumab works just as well, with lower risks. I would like to know your opinion.”

Yes and no.