Ocrevus
Ocrevus: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Ocrevus
ATX code: L04AA36
Active ingredient: ocrelizumab (Ocrelizumab)
Manufacturer: Roche Diagnostics, GmbH (Germany)
Description and photo update: 2019-09-07
Ocrevus is a drug used to treat multiple sclerosis.
Release form and composition
Dosage form - concentrate for preparation of solution for infusion: transparent or somewhat opalescent, from slightly brownish to colorless (10 ml each in colorless glass vials; in a cardboard box 1 bottle and instructions for use of Ocrevus).
Composition for 10 ml (1 bottle) of concentrate:
- active substance: ocrelizumab - 300 mg;
- auxiliary components: sodium acetate trihydrate - 21.4 mg; polysorbate 20 - 2 mg; α, α-trehalose dihydrate - 400 mg; glacial acetic acid - 2.5 mg; water for injection - up to 10 ml.
Pharmacological properties
Pharmacodynamics
Ocrevus's active ingredient, ocrelizumab, is a recombinant humanized monoclonal antibody that selectively targets B cells that express CD20.
CD20 is a surface antigen located on pre-B cells, mature B cells, and memory B cells. CD20 is not expressed on plasma cells and lymphoid stem cells.
The exact mechanism of therapeutic action in MS (multiple sclerosis) is not fully understood. There is an assumption that it includes the process of immunomodulation by reducing the number and suppression of the function of B cells that express CD20. Ocrelizumab, after binding on the surface of B-cells expressing CD20, selectively reduces their number due to antibody-dependent cellular phagocytosis, complement-dependent cytotoxicity, antibody-dependent cellular cytotoxicity and apoptosis. At the same time, the ability of B cells to restore and the existing humoral immunity are preserved. The substance does not affect the total number of T cells and innate immunity.
After 14 days of ocrelizumab therapy, a rapid depletion of the pool of CD19 + B cells in the blood is observed, which persists throughout the entire period of Ocrevus use and is the expected pharmacological effect. For the purpose of counting the number of B cells, CD19 is used, since during the analysis ocrelizumab interferes with the recognition of CD20.
In the periods between the use of Ocrevus, the B-cell pool was restored (to the initial value or above the lower limit of the norm), at least once in about 5% of patients.
The degree and duration of B-cell depletion in patients with PPMS (primary progressive multiple sclerosis) and recurrent MS are similar in studies.
As a result of the longest follow-up period since the last infusion with Ocrevus (during the II phase of the study, N = 51), the median period of recovery of the B-cell pool (return to the initial value or the lower limit of the norm, if it is less than that) is in the range from 27 to 175 weeks (average 72 weeks). The B-cell pool in 90% of cases recovered to baseline or lower normal values approximately 30 months after the last Ocrevus infusion.
The safety and efficacy profile of Ocrevus was assessed in patients with recurrent forms of MS (based on the McDonald 2010 diagnostic criteria) in two double-blind, randomized clinical trials with an identical design, double sham, and using an active comparison drug (interferon beta-1a).
In comparison with therapy with interferon beta-1a (subcutaneously 3 times a week at 0.044 mg), ocrelizumab (every 24 weeks at 600 mg) leads to a significant decrease in the average annual frequency of relapses (the indicators of the average annual frequency of relapses are 0.29-0.292 and 0.155-0.156 respectively), as well as the proportion of patients with progression of disability 12 weeks after the start of treatment (15.2 and 9.8%, respectively).
The safety and efficacy profile of Ocrevus was evaluated in a double-blind, randomized, placebo-controlled clinical study in patients with PPPC. It was found that ocrelizumab, when used every 6 months at a dose of 600 mg, significantly slowed the progression of the disease and, compared with placebo, reduced the deterioration in walking speed.
Patients participating in PC studies were tested for the presence of ATT (anti-therapeutic antibodies) at multiple time points (prior to the first dose and every 6 months throughout the study). A positive test result for ATT was noted in about 1% of cases, while some patients showed a positive test result for neutralizing antibodies. It is impossible to assess the influence of ATT developed during treatment on the efficacy and safety profile of therapy.
Information on immunogenicity is largely determined by the sensitivity and specificity of the assay methods used. Also, with the assay method used, the actual frequency of positive results may be influenced by several factors, including drug interactions, sample collection time, sample handling, concomitant medications, and underlying disease. Thus, the comparison of the frequency of occurrence of antibodies to Ocrevus and other drugs may be incorrect.
Pharmacokinetics
Patients with recurrent forms of MS received 600 mg of Ocrevus once every 6 months (the first dose was administered as two separate intravenous infusions of 300 mg with an interval of 2 weeks, subsequently 600 mg of the drug was administered as a single infusion).
For patients with PPMS, Ocrevus was injected at 600 mg (the first and all subsequent doses were administered as two separate intravenous infusions of 300 mg with an interval of 2 weeks).
In studies of MS, the pharmacokinetic properties of ocrelizumab are described using a two-chamber model with time-dependent clearance and using pharmacokinetic parameters that are characteristic of an IgG1 monoclonal antibody.
The total AUC values (area under the concentration-time curve) during dosing intervals of 24 weeks were identical with a single (600 mg) and double (300 mg) and double (300 mg, then another 300 mg after 2 weeks) administration of the drug. The AUC t (area under the concentration-time curve over the dosing period - t) after the fourth administration of 600 mg ocrelizumab was 3.51 mg / ml per day. The average C max (maximum concentration) of the substance in relapsing forms of MS was 0.212 mg / ml (infusion of 600 mg), with PPMS - 0.141 mg / ml (300 mg, then another 300 mg after 2 weeks).
Ocrelizumab is given intravenously. Other routes of administration of the substance have not been studied.
The calculated value of the central V d (volume of distribution) is 2.78 liters. The calculated value of peripheral V d and inter-chamber clearance are 2.68 l and 0.294 l / day, respectively.
Separate studies of ocrelizumab metabolism have not been conducted. As with other antibodies, ocrelizumab is primarily subject to catabolism.
The estimated constant clearance rate is 0.17 l / day. The initial time-dependent clearance is 0.0489 L / day, with a further decrease at T 1/2 (half-life) of 33 weeks. The terminal T 1/2 value is 26 days.
The pharmacokinetic processes of ocrelizumab in children and adolescents under the age of 18 years and in elderly patients aged 65 and over have not been studied.
Separate studies of pharmacokinetics in patients with impaired renal and hepatic function have not been conducted. Patients with mild hepatic and renal impairment (with creatinine clearance> 45 ml / min) were included in the program of clinical trials. In these patients, no changes in the pharmacokinetic parameters of ocrelizumab were observed.
Indications for use
- multiple sclerosis in recurrent forms;
- primary progressive multiple sclerosis.
Contraindications
Absolute:
- active hepatitis B;
- burdened history of life-threatening infusion reactions that occurred when using Ocrevus;
- pregnancy and lactation;
- age up to 18 years;
- individual intolerance to the components of the drug.
Relative (Ocrevus is prescribed under medical supervision):
- impaired renal function of moderate and severe severity;
- congestive heart failure (NYHA class III and IV);
- immunization with live attenuated and live viral vaccines;
- age ≥ 65 years.
The use of Ocrevus may increase the likelihood of malignancy, including the risk of breast cancer.
Ocrevus, instructions for use: method and dosage
The solution prepared from the concentrate Ocrevus should be injected only intravenously using a separate catheter. Jet and bolus administration of the drug is prohibited.
Infusion should be performed under the close supervision of an experienced healthcare professional. Access to emergency supplies should be ensured in the event of severe reactions, including severe infusion responses. After completion of the infusion, the patient should be monitored for at least one hour for the development of these disorders.
In order to reduce the frequency and severity of infusion reactions, premedication with methylprednisolone (bioequivalent drug can be used) must be carried out intravenously at a dose of 100 mg, approximately 30 minutes before the infusion, before each administration of Ocrevus.
To further reduce the severity and frequency of infusion reactions, additional premedication with an antihistamine agent (eg, diphenhydramine) is recommended approximately 30-60 minutes before each OCREVUS infusion. If clinically necessary, premedication with an antipyretic (eg paracetamol / acetaminophen) may be required approximately 30-60 minutes before starting the Ocrevus infusion.
The recommended dosage regimen is 600 mg once every 6 months.
The initial dose is administered as two separate infusions: 300 mg in 250 ml with a break of 2 weeks. The introduction begins at a rate of 30 ml / h, gradually the rate can be increased once every 30 minutes in increments of 30 ml / h to a maximum of 180 ml / h. The average duration of the infusion is 2.5 hours.
In the future, all subsequent doses of Ocrevus are administered as a single infusion every 6 months at 600 mg in 500 ml. The introduction begins at a rate of 40 ml / h, gradually the rate can be increased once every 30 minutes in increments of 40 ml / h to a maximum of 200 ml / h. The average duration of the infusion is 3.5 hours.
The first of the subsequent infusions should be given 6 months after the initial dose. The minimum interval between the administration of Okrevus should be 5 months.
If a miss has occurred in the planned administration, it is necessary, without waiting for the next planned application, to enter the recommended dose of Ocrevus as soon as possible. In the future, it is necessary to adjust the schedule for using the drug to maintain a six-month interval.
In cases where the development of symptoms of disabling or life-threatening infusion reactions, including acute respiratory distress syndrome or acute hypersensitivity, is noted during the infusion, the administration of Ocrevus should be interrupted immediately. Appropriate supportive therapy is prescribed. Such patients require a complete withdrawal of the drug without resuming therapy in the future.
If a severe infusion reaction occurs or if facial flushing, sore throat and fever occur simultaneously, the infusion is immediately interrupted. Symptomatic treatment is required. You can resume using Ocrevus only after all symptoms have resolved. When resuming infusion, the initial rate should be half the rate at which the response began.
If the infusion reactions are mild or moderate (for example, in the form of a headache), the infusion rate should be reduced by 2 times at the onset of manifestation. Continue administration at this reduced rate for at least 30 minutes. If well tolerated, the infusion rate can be increased according to the original schedule.
Breeding of Okrevus is carried out by medical personnel in aseptic conditions. The concentrate does not contain preservatives, therefore the preparation is intended for single use only.
In the concentrate, the presence of finely dispersed light reflecting and / or transparent particles is permissible, while an increase in opalescence is noted. If the color changes or there are discrete foreign inclusions, the drug should not be used.
Administration of Ocrevus should be done using an in-line filter infusion set with a pore diameter of 0.2 or 0.22 microns.
The concentration of the finished solution is approximately 1.2 mg / ml. For its preparation, the concentrate must be diluted in an infusion bag containing 0.9% sodium chloride solution in the ratio of 300 mg per 250 ml or 600 mg per 500 ml. Dilution in other solvents has not been tested.
The contents of the infusion bag immediately before infusion should be at room temperature, this will avoid the development of an infusion reaction, which is associated with the introduction of a low temperature solution.
The solution for infusion, from the point of view of microbiological purity, must be used immediately after preparation. In exceptional cases, it is allowed to store the finished solution at a temperature of 2–8 ° C for no more than 24 hours or at room temperature for 8 hours.
Ocrevus solution is compatible with polyolefin or PVC infusion bags and intravenous systems.
Side effects
The most common side effects with Ocrevus were respiratory tract infections and infusion reactions.
Adverse reactions observed during clinical trials of the drug in patients with PPPC and with recurrent forms of the disease [> 10% - very often; (> 1% and 0.1% and 0.01% and <0.1%) - rarely; <0.01% - very rare]:
- infectious and parasitic diseases: very often - nasopharyngitis, upper respiratory tract infections, flu; often - bronchitis, sinusitis, herpes of the oral mucosa, shingles (Herpes Zoster), viral infection, respiratory tract infections;
- complications of manipulation and intoxication: very often - infusion reactions;
- organ of vision: often - conjunctivitis;
- skin and subcutaneous tissues: often - inflammation of the subcutaneous fatty tissue;
- respiratory system: often - catarrhal phenomena, cough.
Symptoms characteristic of infusion reactions: nausea, shortness of breath, swelling of the larynx or pharynx, low blood pressure, rash, itching, urticaria, erythema, hot flashes, fever, tachycardia, fatigue, dizziness, headache, oropharyngeal pain, throat irritation …
No fatal infusion reactions have been reported in controlled clinical trials.
Infusion reactions in recurrent forms of MS were the most common side effects with Ocrevus 600 mg. The overall frequency of infusion reactions with Ocrevus and interferon beta-1a was 34.3% and 9.9%, respectively.
The maximum frequency of infusion reactions in PPMS and recurrent disease was observed during the first infusion of the first dose (27.4–27.5%), over time this indicator decreased to <10% during the fourth dose. In most cases, infusion reactions were mild to moderate in severity.
Compared to patients in control groups, there was no increase in the incidence of serious infections in patients undergoing Ocrevus therapy. The incidence of serious infections with PPMS was similar to that in the placebo group, with a recurrent form of the disease - lower than during treatment with interferon beta-1a.
In controlled clinical trials, respiratory tract infections and herpetic infections (mainly mild to moderate severity) were more often observed during the use of Ocrevus than in patients from the control groups.
Respiratory tract infections were more common in patients treated with Ocrevus than in patients treated with interferon beta-1a or placebo. In most cases, these disorders were mild to moderate in severity. The most common adverse reactions include upper respiratory tract infections (including nasopharyngitis) and bronchitis.
In comparison with patients from the interferon beta-1a group, the incidence of herpes infection in patients with recurrent forms of MS was higher during Ocrevus therapy. The comparative frequency of the development of disorders in the groups of the drug interferon beta-1a and Ocrevus: shingles (Herpes Zoster) - 1 and 2.1%; oral herpes - 2.2 and 3%; herpes simplex - 0.1 and 0.7%; genital herpes, herpes viral infection - 0 and 0.1%, respectively. Infections were mostly mild to moderate, and patients recovered after standard treatment. There were no cases of disseminated herpes.
Herpes of the oral mucosa in patients with PPMS in a clinical study using Ocrevus and placebo developed with a frequency of 2.7 and 0.8%, respectively.
There are data from clinical studies of the use of Ocrevus in combination with immunosuppressive therapy (against the background of long-term use of drugs such as glucocorticosteroids, biological and synthetic disease-modifying antirheumatic drugs, cyclophosphamide, mycophenolate mofetil, azathioprine) for rheumatoid arthritis and other autoimmune diseases.
As follows from the results of studies with the participation of patients with rheumatoid arthritis, there was an imbalance of serious infections in the group of Ocrevus and immunosuppressants, in particular, histoplasmosis, tuberculosis, SARS and pneumonia caused by chickenpox virus and Pneumocystis jirovecii. The above infectious complications were fatal in rare cases. Serious infections have been observed more frequently with Ocrevus 1000 mg concomitantly with immunosuppressants, compared with its 400 mg dose or immunosuppressive therapy plus placebo.
The main risk factors for the development of serious infections: the presence of concomitant diseases, long-term therapy with glucocorticosteroids / immunosuppressants, and the patient's belonging to the Asian region.
During the period of Ocrevus therapy, a decrease in the total concentration of immunoglobulins was noted, mainly due to a decrease in the level of IgM (immunoglobulin M). There was no correlation with the development of serious infections.
The initial concentrations of IgG, IgA and IgM before the start of Ocrevus use in the clinical study were less than the lower limit of the norm at 0.5; 1.5% and 0.1% of patients with recurrent forms of MS, respectively. 96 weeks after the start of therapy, the value of this indicator changed to 1.5; 2.4 and 16.5%, respectively.
The proportion of PPMS patients in the Ocrevus group in a placebo-controlled study with baseline IgG, IgA and IgM levels less than the lower limit of normal was 0; 0.2 and 0.2%, respectively. 120 weeks after the start of therapy, the value of this indicator changed to 1.1; 0.5 and 15.5%, respectively.
In patients with recurrent forms of MS who received Ocrevus, a decrease in the number of neutrophils was noted less frequently compared with patients who received interferon beta-1a (14.7% and 40.9%, respectively). In patients with PPMS treated with Ocrevus, a decrease in the number of neutrophils was observed slightly more often compared with patients receiving placebo (12.9 and 10%, respectively).
Most often, the decrease in the number of neutrophils against the background of the use of Ocrevus was of a transient nature, during therapy it was noted no more than once and had I or II severity. Violation in the III or IV degree of severity was recorded in about 1% of patients, there was no correlation with the development of infection.
Overdose
Experience with Ocrevus in excess of recommended doses is limited. The maximum dose studied was 2000 mg in two infusions (1000 mg each with a break of 2 weeks), the adverse reactions observed in this case corresponded to the safety profile of Ocrevus.
If the dose of the drug is exceeded, the infusion should be interrupted immediately and the patient's condition should be monitored for the development of infusion reactions. There is no specific antidote.
special instructions
Infusion reactions occurring during the use of Ocrevus may be associated with the release of chemical mediators and / or cytokines. This disorder can develop during any infusion, but most often it occurs with the introduction of the first dose. Also, these reactions can occur within 24 hours after infusion.
The main symptoms of infusion reactions: itching, urticaria, rash, erythema, throat irritation, shortness of breath, hot flashes, swelling of the larynx or pharynx, pain in the oropharynx, fever, lowering blood pressure, fatigue, dizziness, headache, tachycardia, nausea. The patient's condition should be carefully monitored for the development of symptoms of infusion reactions for at least one hour after the end of the infusion.
During Ocrevus therapy, hypersensitivity reactions (in the form of an acute allergic reaction to ocrelizumab) may occur. Infusion reactions can be clinically difficult to distinguish from acute type I (IgE-mediated) hypersensitivity reactions.
In the event of severe respiratory symptoms (in the form of bronchospasm or an episode of exacerbation of bronchial asthma), the infusion should be stopped immediately. Further treatment with Ocrevus is prohibited.
After symptomatic therapy, until the symptoms of the respiratory system are completely resolved, the patient should be monitored, since after the initial improvement, their deterioration is likely to develop. During the infusion, there is a risk of lowering blood pressure, which can be attributed to the symptoms of infusion reactions. Therefore, it may be necessary to suspend treatment with antihypertensive drugs for 12 hours before and during each infusion of Ocrevus. In patients with a history of congestive heart failure (NYHA Class III and IV), Ocrevus has not been studied.
During the course of controlled clinical trials, there were no reports of the development of hypersensitivity reactions.
There is a possibility of complications in the differential diagnosis of hypersensitivity reactions and infusion reactions. The former can occur during any infusion, but they usually do not develop during the first dose.
In cases where, with the introduction of subsequent doses, previously observed symptoms are aggravated or the development of new severe symptoms is noted, the likelihood of a hypersensitivity reaction should be immediately considered. If this violation is suspected, the infusion is immediately canceled and the therapy is not resumed in the future. Patients who have established IgE-mediated hypersensitivity to Ocrevus, its use is contraindicated.
If there is an active infection, the administration of Ocrevus should be postponed until it stops.
PML (progressive multifocal leukoencephalopathy) is an opportunistic viral infection of the brain caused by the John Cunningham virus (JC virus), in most cases manifests itself in patients with immunodeficiency. The development of PML usually leads to severe disability or death.
In clinical trials, no cases of PML were detected, however, JC-associated PML was observed in patients undergoing therapy with other antibodies to CD20, as well as other drugs for the treatment of MS. Risk factors for the development of JC-associated PML: multiple therapy with immunosuppressants, immunodeficiency.
If you suspect PML, you need to suspend the use of Ocrevus and conduct a diagnosis. Signs of PML can be detected on an MRI scan even before clinical symptoms develop.
PML has a variety of symptoms that can worsen over days to weeks. These include progressive weakness on one side of the body, visual impairment, clumsiness of the limbs, changes in thinking, orientation, and memory, leading to personality changes and confusion. These symptoms and signs may be similar to those of MS recurrence. If the diagnosis of PML is confirmed, treatment should be stopped completely.
No episodes of hepatitis B reactivation were reported in MS patients who received Ocrevus therapy. There is information about the reactivation of HBV (hepatitis B virus) during treatment with antibodies to CD20. In some cases, this led to the development of liver failure, fulminant hepatitis, and death. All patients should be screened for HBV prior to prescribing Ocrevus. If active HBV is present, the drug should not be used.
In the presence of positive serological markers of hepatitis B (with a negative test for HBsAg and a positive result for HBcAb), as well as in patients with HBV (with a positive result for HBsAg), it is necessary to consult a hepatologist before prescribing Ocrevus. Their condition is required to establish appropriate medical supervision, preventive measures are required to reactivate HBV.
It is necessary to prescribe Ocrevus after immunosuppressive therapy or immunosuppressive therapy after using Ocrevus, taking into account that their pharmacodynamic effects may overlap.
The safety of immunization with live attenuated or live viral vaccines after treatment with Ocrevus has not been studied. It is not recommended to vaccinate with the indicated vaccines during the use of the drug, as well as until the B-cell pool is restored.
The number of patients with positive tigers antibodies to S. pneumoniae, mumps, chickenpox and rubella after treatment for 2 years was generally similar to that before treatment.
There is no information available on the effects of vaccination in patients using Ocrevus. The patient's immunization status should be reviewed prior to prescribing the drug. If it is necessary to vaccinate, it should be completed at least 6 weeks before the start of Ocrevus.
During therapy, the risk of malignancy may be increased. Malignancy, including the development of breast cancer, in controlled clinical trials, was more often observed in patients receiving Ocrevus than in patients receiving interferon beta-1a or placebo. Patients must adhere to the standard guidelines for breast cancer screening.
The destruction of an expired drug or an unused drug must be carried out in accordance with the requirements of the medical institution. Do not dispose of Ocrevus with waste water or with household waste.
Influence on the ability to drive vehicles and complex mechanisms
The effect of Ocrevus on the ability to drive vehicles has not been studied.
Application during pregnancy and lactation
Ocrevus is not prescribed during pregnancy / lactation.
Women with intact reproductive function during therapy and for 6 months after the last infusion should use effective methods of contraception.
Ocrelizumab belongs to the G1 subtype immunoglobulins and is thought to cross the placental barrier.
In clinical studies, the change in the number of B cells in newborns whose mothers used Ocrevus has not been studied. There are no data from controlled trials of ocrelizumab in which pregnant women were involved.
Some infants whose mothers received other antibodies to CD20 during pregnancy experienced temporary depletion of the peripheral B-cell pool and lymphocytopenia.
It was found that ocrelizumab passes into the milk of experimental animals during lactation.
There is no information about whether ocrelizumab is excreted in human breast milk and whether therapy has an effect on its production. The potential harm to a breastfed baby has not been established.
Human IgG passes into breast milk, but the possibility of absorption of ocrelizumab and the subsequent depletion of the B-cell pool has not been established.
Pediatric use
Ocrevus is not prescribed for patients under 18 years of age.
With impaired renal function
During clinical studies in the treatment of patients with mild renal impairment with creatinine clearance of more than 45 ml / min, no changes in the pharmacokinetic parameters of ocrelizumab were observed.
Ocrevus is prescribed with caution in patients with moderate to severe renal impairment.
Since ocrelizumab is eliminated by catabolism and not by renal excretion, it can be assumed that a change in dosing regimen for impaired renal function is not required.
For violations of liver function
During clinical studies in the treatment of patients with mild liver dysfunction, no changes in the pharmacokinetic parameters of ocrelizumab were observed.
Since ocrelizumab is excreted by catabolism and not by hepatic metabolism, it can be assumed that a change in dosing regimen in case of impaired liver function is not required.
Use in the elderly
Ocrevus is used with caution in patients over 65 years of age.
Drug interactions
With the combined use of Ocrevus with immunomodulatory and immunosuppressive therapy, including the use of glucocorticosteroids in immunosuppressive doses, an increase in the likelihood of immunosuppression is expected, therefore the risk of an additive effect on the immune system must be considered.
In cases of transfer of a patient from therapy with drugs with a prolonged effect on the immune system (daclizumab, fingolimod, natalizumab, teriflunomide or mitoxantrone) to Ocrevus, the duration and mechanism of action of these drugs (due to the likelihood of an additive effect on the immune system) should be taken into account.
Separate studies of the interaction of ocrelizumab with other drugs have not been conducted. This is due to the fact that no interactions are expected that are associated with the activity of cytochrome P 450 isoenzymes and other metabolizing enzymes or transporters.
Analogs
Orevus analogs are Betaferon, Copaxon 40, Copaxon-Teva, Alfarona, Extavia, Taktivin, Reaferon-EC, Rebif, Ronbetal, Avonex, etc.
Terms and conditions of storage
Store in a place protected from light, at a temperature of 2-8 ° C, in a cardboard box. Keep out of the reach of children.
Shelf life is 2 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Ocrevus
There are few reviews about Ocrevus, since the drug was recently registered and has a high cost. Its advantages include high efficiency, practically unparalleled, good tolerance and convenient dosing regimen.
Price for Ocrevus in pharmacies
The approximate price for Ocrevus (1 bottle of 10 ml) is 248,000–257,000 rubles.
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
