Last reply 2 months ago
Immunosuppressant versus IRT

Am I right in thinking that Ocrevus is an immunosuppressant whereas Lemtrada is an Immune Reconstitution Therapy ?

If so, does that mean your vulnerability to opportunistic infection is permanent all the time you are on Ocrevus whereas with Lemtrada, once your immune system ‘rebuilds’, it is back to normal (assuming you don’t get a secondary auto-immune problem)?

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mlgilber1
2 months ago

I’m on Ocrevus and it is an immunosuppressant so you’re more at risk for infections. I know respiratory infections can be a side effect because of it. Some people seem to get sick more and some less. I personally have been sick less since starting. I only started in September, but I used to get sick all the time and my sons been sick a few times and I haven’t gotten sick from him which I usually do. I haven’t been sick since starting it, but did get a UTI which is common and shingles.


dominics
2 months ago

I believe Ocreluzimab is an IRT, in so far as it depletes the immune system to a certain extent. Am a bit hazy on this exact part.

This fellow is good – I subscribe to his YouTube channel.


dominics
2 months ago

guppy
2 months ago

I’m also hazy (& very out of my depth 🙂 ) but, after I posted this question, the MS Trust sent me a link to the following from Prof G which I found quite useful. It talks about maintenance vs. IRT and puts Ocrevus (as currently used) in the Maintenance camp.

https://www.medscape.org/viewarticle/892112_sidebar2


guppy
2 months ago

Not sure if maintenance = immunosuppressant though ??


doyles2
2 months ago

@guppy – thanks very much for the Medscape link, a very helpful overview of all the available DMTs.
The slides indicate that immunosuppressants (Natalizumab etc) are a subset of maintenance treatments – the full set of maintenance treatment/maintenance DMTs includes immunomodulators such as Glatiramer Acetate and BetaInterferon….I’m guessing here but I’m assuming that immunosuppressors must suppress/weaken the immune system whereas immunomodulators can alter the way in which the immune system operates (likely with the same intended impact).


dominics
2 months ago

@guppy – why is it so important to know the distinction?


guppy
2 months ago

@dominics – to answer your question, from reading around the pros & cons of Ocrevus & Lemtrada, it seemed that this distinction might be important to weighing the two up.

All other things being equal (which of course they aren’t – esp. side effects) I guess I have a preference for a treatment that hopefully ‘fixes’ my immune system and leaves it working rather than one that suppresses it forever and was trying to get to the bottom of whether that description is correct. The Medscape link above helps explain the differences but I’m still not sure my above simplification is really correct. Will keep reading!


dominics
2 months ago

You can over-research! Sounds like you are v well informed and if you put the same to your neuro as you did here their answer ought to be illuminating.


guppy
2 months ago

Yes – I do feel a bit overloaded now! Will take a breather I think. Thanks so much for your answers and previous posts on here – I’ve found them really helpful.


dominics
2 months ago

@guppy – is there an expectation that you make a choice by a certain time?

I was pondering as it is a really interesting question – a bit of a conundrum really! – as I felt I had to cast my lot one way.

You have the relative luxury of being able choose fairly early on, so I guess the real choice is about which medication gives you – in all your particular clinical circumstances – the best long term prognosis.

Finding a neurologist who will engage with that sort of approach by their patient is as important. You want to be confident in the choice you are steered towards.

Good luck and keep us updated.

Best,

Dominic

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