After nine infusions of Ocrevus (typically 4.5 years of treatment), your MS should ideally show significant disease stabilization, but the exact outcome depends on your MS type (RRMS or PPMS) and individual response. Here’s what to expect:
1. If You Have Relapsing-Remitting MS (RRMS):
- Relapse Reduction: By this stage, most RRMS patients experience far fewer or even zero relapses (studies show ~50% reduction in annual relapses after 1–2 years, with further suppression over time).
- MRI Stability: No (or very few) new/enhancing lesions if Ocrevus is effective.
- Disability Progression: Many remain stable on the EDSS scale, though some may still see gradual progression (but slower than without treatment).
Red Flags (RRMS):
- If you’re still having relapses, worsening symptoms, or new lesions on MRI, Ocrevus may not be fully effective for you.
- Ask your neurologist about:
- Checking B-cell levels (Ocrevus should keep them near zero; early repopulation may mean needing dose adjustments).
- Switching to another high-efficacy DMT (e.g., Kesimpta, Tysabri, or Briumvi).
2. If You Have Primary Progressive MS (PPMS):
- Slowed Progression: Ocrevus won’t stop PPMS but can delay disability (e.g., wheelchair dependence by ~6–12 months vs. placebo, per the ORATORIO trial).
- Symptom Stability: You may notice slower decline in mobility, strength, or cognition, but existing damage won’t reverse.
Red Flags (PPMS):
- Rapid progression (e.g., needing a wheelchair sooner than expected) suggests Ocrevus isn’t working optimally.
- Discuss alternatives like symptomatic therapies (e.g., Ampyra for walking, PT/OT) or clinical trials.
3. Symptom Management After 4.5 Years
Even with good disease control, you might still deal with:
- Fatigue, spasticity, or neuropathic pain → Managed with medications (e.g., amantadine, baclofen, gabapentin) and lifestyle changes.
- Walking difficulties → Physical therapy or dalfampridine (Ampyra) may help.
- Cognitive changes → Brain training, occupational therapy.
4. Key Questions to Ask Your Neurologist
- “Has my MRI been stable since starting Ocrevus?”
- “Am I progressing faster than expected for my MS type?”
- “Are there other treatments if Ocrevus isn’t enough?”
- “Should we check my B-cell levels?”
When to Consider a Change
- New/worsening symptoms + active MRI lesions → May need a different DMT.
- No relapses but gradual progression (common in PPMS) → Focus on symptom management and rehab.
Bottom Line
After 9 infusions, Ocrevus should have significantly slowed your MS activity, but outcomes vary. If you’re stable, continue treatment; if progressing, explore alternatives.
Are you noticing improvement, stability, or worsening? That’ll help determine next steps. Let me know if you’d like guidance on specific symptoms or treatments!