Q&A 90: Ocrelizumab wearing-off phenomenon

My neurologist wants me to switch to ublituximab as an alternative. He believes that ublituximab is not associated with the wearing-off effect. Would you recommend I switch?

Case study

I am a 34-year-old woman with relapsing-remitting multiple sclerosis. I was started on ocrelizumab close to four years ago. However, at about 5-6 weeks before my next infusion, I notice my cog-fog returning, fatigue, and difficulty concentrating. Sometimes this can be so bad that I must take time off work. I am aware from Facebook that ocrelizumab wearing-off is quite common. My neurologist wants me to switch to ublituximab (Briumvi) as an alternative. He believes that ublituximab is not associated with the wearing-off effect. Would you recommend I switch?

Cog-fog is a common symptom reported as part of the ocrelizumab WoP

NOTE: General Substack newsletters and the microsite are free; only Q&A sessions are restricted to paying subscribers. I can't run and maintain the MS-Selfie microsite, so I must pay people to help me do the work. If people want to ask medical questions unrelated to the Newsletters or Podcasts, they either need to become paying subscribers or email (ms-selfie@giovannoni.net) to request a complimentary subscription.

Prof G’s answers

By looking into the so-called ocrelizumab "wearing-off" phenomenon (WoP) or "crap gap," I seem to have opened a can of worms. Instead of taking sides, I have summarised the current evidence supporting the presence of WoP as best I can and its potential treatment. It is a very controversial subject.