Q&A 93: severe fatigue after switching from ocrelizumab to ofatumumab

I would not be surprised if she has new spinal cord lesions or a raised CSF neurofilament level and needs a more effective DMT.

Case study

I am 42 years of age and have been on ofatumumab for 14 months. Before this, I had been treated with ocrelizumab (Ocrevus) and before this, dimethyl fumarate (Tecfidera). I was switched from ocrelizumab to ofatumumab because of mild persistent lymphopaenia. My lymphocyte counts were around 0.7 to 0.9. My counts have recovered on ofatumumab and now run at 1.1 to 1.2. However, over the last 12 months, my MS fatigue has gotten a lot worse. I have not had any relapses, and my brain MRI has been stable with no new lesions. My neurologist seems to be ignoring my fatigue and has suggested I am depressed. My mood is low, but it is in response to my fatigue. I am finding work increasingly difficult, and I rarely go out because of the fatigue. I have stopped exercising and have no libido. I never feel refreshed after a night’s sleep. What can I do about my MS fatigue?

How long is a piece of string?

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Prof G’s answers

Asking about MS fatigue is like asking how long a piece of string is.

I hope you don’t mind me addressing your email with the following questions?

1. Is your neurologist gaslighting you when he/she ignores your fatigue?

2. What is MS fatigue, and how do you diagnose it?

3. What else could be causing your fatigue?

4. What about lymphopaenia after DMF on ocrelizumab?