C-PO Leads to Less Sedation Complications in Patients With MS on Ocrelizumab

The combination of cetirizine, dexamethasone, and famotidine is a safe premedication for ocrelizumab that has less sedation complications among patients with multiple sclerosis (MS), according to study results presented at the 2024 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held in Nashville, Tennessee, from May 29 to June 2, 2024.

The prescribing information for ocrelizumab recommends use of a corticosteroid and antihistamine premedication to reduce risk for infusion-related symptoms (IRS). However, this premedication is associated with drowsiness, malaise, insomnia, and increased appetite.

To assess whether an alternative premedication may decrease IRS and ease administration, researchers from The Elliot Lewis Center for Multiple Sclerosis Care in the United States conducted this study. Patients (N=50) with MS who were currently receiving 600 mg ocrelizumab and 50 mg oral diphenhydramine plus 250 mg intravenous dexamethasone plus 20 mg oral famotidine (D-IV) and had no history of IRS were recruited for this study. The patients received 1 cycle of D-IV and 1 cycle of 10 mg oral cetirizine plus 20 mg oral dexamethasone plus 20 mg oral famotidine (C-PO). The patients were surveyed about their symptoms during and 24 hours after their ocrelizumab infusions.

As of April 2024, 31 patients had received both premedication cycles.

A total of 68% of patients reported IRS with D-IV premedication and 67.7% of patients reported IRS with C-PO premedication. Moderate to severe IRS were reported by 20% of patients with D-IV premedication compared with 10% of patients with C-PO premedication.

More patients reported being less alert following premedication with D-IV (86%) than after premedication with C-PO (38.7%). Similarly, more patients reported moderate to severe decreased alertness following premedication with D-IV (48%) than after premedication with C-PO (12.9%).

This study was limited by the small sample size and the lack of blinding to premedication.

“Early data from this study indicates that patients on OCR [ocrelizumab] receiving C-PO have similar frequency and severity of IRS, but less sedation, than patients receiving D-IV. C-PO appears to be a safe and effective premedication regimen for OCR, can ease administration and potentially shorten overall treatment time,” the researchers concluded.