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ocrelizumab

Sold as Ocrevus. Class: Monoclonal antibodies. First FDA approval 03/28/2017: 9 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

B

Score breakdown (80/100)

Safety ×35%
A
Evidence ×25%
D
Regulatory ×15%
A
Money & lawsuits ×15%
C
Options ×10%
C

Safety: 100

Evidence: 53

Regulatory history: 95

Money & lawsuits: 70

Options: 70

What the FDA label says

Approved uses

is indicated for the treatment of: Relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults Primary progressive MS, in adults Relapsing-remitting MS, in pediatric patients 10 years of age and older who weigh 25 kg or more. OCREVUS is a CD20-directed cytolytic antibody indicated for the treatment of: Relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults ( 1 ) Primary progressive MS, in adults ( 1 ) Relapsing-remitting MS, in pediatric patients 10 years of age and older who weigh 25 kg or more ( 1 )

Contraindications

is contraindicated in patients with: Active HBV infection [see Dosage and Administration (2.1) and Warnings and Precautions (5.2) ] A history of life-threatening infusion reaction to OCREVUS [see Warnings and Precautions (5.1) ] Active hepatitis B virus infection ( 4 ) History of life-threatening infusion reaction to OCREVUS ( 4 )

Warnings and precautions

Infusion Reactions: Management recommendations for infusion reactions depend on the type and severity of the reaction. Permanently discontinue OCREVUS if a life-threatening or disabling infusion reaction occurs ( 2.3 , 5.1 ) Infections: Serious, including life-threatening and fatal infections, have occurred. Delay OCREVUS administration in patients with an active infection until the infection is resolved. Vaccination with live-attenuated or live vaccines is not recommended during treatment with OCREVUS and after discontinuation, until B-cell repletion ( 5.2 ) Progressive Multifocal Leukoencephalopathy (PML): Withhold OCREVUS at the first sign or symptom suggestive of PML ( 5.3 ) Reduction in Immunoglobulins: Monitor the level of immunoglobulins at the beginning of treatment. Monitor during and after discontinuation of treatment with OCREVUS, until B-cell repletion, and especially when recurrent serious infections are suspected. Consider discontinuing OCREVUS in patients with serious opportunistic or recurrent serious infections, and if prolonged hypogammaglobulinemia requires treatment with intravenous immunoglobulins ( 2.1 , 5.4 ) Malignancies: An increased risk of malignancy, inc...

Adverse reactions (label)

The following serious adverse reactions are discussed elsewhere in the labeling: Infusion Reactions [see Warnings and Precautions (5.1) ] Infections [see Warnings and Precautions (5.2) ] Progressive Multifocal Leukoencephalopathy [see Warnings and Precautions (5.3) ] Reduction in Immunoglobulins [see Warnings and Precautions (5.4) ] Malignancies [see Warnings and Precautions (5.5) ] Immune-Mediated Colitis [see Warnings and Precautions (5.6) ] Liver Injury [see Warnings and Precautions (5.7) ] The most common adverse reactions were: RMS (incidence ≥10% and > REBIF ® ): upper respiratory tract infections and infusion reactions ( 6.1 ) PPMS (incidence ≥10% and > placebo): upper respiratory tract infections, infusion reactions, skin infections, and lower respiratory tract infections ( 6.1 ) RRMS in pediatric patients 10 years of age and older: Adverse reactions were consistent with those observed in adults with RMS ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact Genentech at 1-888-835-2555 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reactions rates observed in the...

Recent major label changes

Indications and Usage ( 1 ) 5/2026 Dosage and Administration ( 2.1 ) 8/2025 Dosage and Administration ( 2.2 , 2.3 , 2.6 ) 5/2026 Warnings and Precautions ( 5.1 , 5.2 ) 5/2026 Warnings and Precautions ( 5.7 ) 8/2025

Source: FDA SPL label for OCREVUS (Genentech, Inc.), effective 20260514. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

61,617reports that mention this drug
61,589of those blame this drug, not another one the person was taking
50%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
2.5%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Covid-19 · 11,573Fatigue · 6,215Urinary Tract Infection · 3,781Headache · 3,265Multiple Sclerosis · 3,026Multiple Sclerosis Relapse · 2,727Gait Disturbance · 2,716Asthenia · 2,705Nasopharyngitis · 2,569Pain · 2,540Fall · 2,529Off Label Use · 2,446Pneumonia · 2,441Drug Ineffective · 2,439Infusion Related Reaction · 2,217

Reports per year

20192020202120222023202420252026
6,2765,5507,19411,4048,9259,5664,5491,965

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

0recall actions on file
0 / 0brand / generic applications
0label changes since 2021
NoREMS program

Evidence base

39randomized trials (PubMed)
10systematic reviews
157registered trials
61%of completed trials posted results
12%terminated or withdrawn
66%industry-funded

Independent Cochrane reviews

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $1,700,823 in payments to US physicians and hospitals tied to this drug across 8,954 transactions (Ocrevus $1,700,823).

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

3,085Medicare Part D patients (2024)
5,163prescriptions filled
$37,782average cost per fill
$195Mtotal Medicare spend

Same-class alternatives

alemtuzumabanifrolumabaxatilimabbelimumabefalizumabemapalumabinebilizumabmuromonab-cd3natalizumabofatumumabrozanolixizumabsibeprenlimabublituximab

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. The most-reported problems in FDA's adverse event data are covid-19, fatigue, urinary tract infection, headache. How would we recognize and handle those?
  2. Why this one over alemtuzumab, anifrolumab, axatilimab? What would make you pick one of those instead?
  3. There is no generic. Is there an older generic in the same class that works as well for my situation?
  4. The manufacturer pays physicians heavily to promote this drug. Have you received anything from them?
  5. What result are we expecting, by when, and what is the plan if it does not happen?
  6. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)