Blood Tests for B-Cell Drugs (Ocrevus, Rituximab, Kesimpta, Briumvi)
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- čas přidán 7. 05. 2024
- I was recently asked to make a video explaining the interpretation of blood tests for people taking drugs which deplete b-lymphocytes. I give a brief explanation of the b-cell lineage, the CD20 receptor, and we look at tests done both prior to treatment and for ongoing monitoring.
Comment or ask questions below! I would be happy to answer!
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Dr. Brandon Beaber is a board-certified neurologist with subspecialty training in multiple sclerosis and other immunological diseases of the nervous system. He is a partner in the Southern California Permanente Medical Group and practices in Downey, California (South Los Angeles). He has several publications on MS epidemiology and has participated in clinical trials for MS therapeutics. You can follow him on twitter @Brandon_Beaber where he regularly posts about MS news and research.
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he video material by Dr. Brandon Beaber is general educational material on health conditions and is not intended to be used by viewers to diagnose or treat any individual's medical condition. Specifically, this material is not a substitute for individualized diagnostic and treatment advice by a qualified medical/health practitioner, licensed in your jurisdiction, who has access to the relevant information available from diagnostic testing, medical interviews, and a physical examination. To the extent that Dr. Beaber endorses any lifestyle change, behavioral intervention, or supplements, the viewer should consult with a qualified healthcare professional to determine the safety and efficacy of the intervention in light of their individualized information. - Věda a technologie
Fantastic video, Dr Beaber. I'm male 57, RRMS, diagnosed 1997. 13 years on Avonex interferon B weekly, 6 years on tecfidera and now on ocrelizumab (Ocrevus) since 2020. My hospital is tailoring the frequency of Ocrevus doses based on blood tests to lengthen the gap as much as possible while maintaining B lymphocyte suppression. It also allows me to have Covid-19, flu and shingles vaccinations once the B cells have recovered enough then 1 month for antibody production then next Ocrevus infusion. It's working well, monitored by periodic MRI scans and only one pseudo-relaps caused by major work stress (I've since retired). It's the best treatment I've ever seen.
This video deals specifically with what's happening to me and what is being monitored closely so is absolutely fascinating! Thanks so much!
Thanks for sharing. How often are you having blood tests?
This info is invaluable. Thank you for caring in a way that reaches those who may not have access to the type of support you offer. ❤
I've been on Ocrevus for about 4 years. No remarkable increase in infection. I'm a 53yo male edss 6.5.
Thanks for sharing.
I’ve been on ocrelizumab since 2008 (Phase II study). After 10 years, many respiratory, ear and other infections. Then Shingles. Not so painful when you can’t feel stuff. Yea MS. Blood tests showed very low immunoglobulin levels. Went on IVIG (intravenous immunoglobulin G). No more infections, but went from 2 infusions/year to 14/year. IVIG is given 2 consecutive days each month plus the 2 Ocrevus infusions.
Hi from Israel very informative data thanks dear doctor
Thanks for the video. Perfect timing for me. Diagnosed last summer. I started Ocrevus in Nov. I am going for my 6 months treatment soon and they will do blood tests prior to my infusion. Now, I am more educated on how to understand my results and what to look for when comparing with my baseline before Ocrevus. Thank you 🙏
Glad it helped. I know it can be very confusing to look at those labs
Thanks Dr. Beaber! I haven’t taken these drugs and wasn’t aware of all the blood tests and how the CD20 cells work.
The blood tests aren't as complicated as they seem. It's what to do with the results which is more controversial.
Currently on "Kesimpta" since last November, but it seems I've developed a secondary progressive MS, thus likely I'll be switched to another medication later this year.
First injection was... impressive. I got no damage to eyes and brains are almost untouched, all damage is from neck down and some in the area where brain and spinal cord meet. So around 4-5 hours after injection my temperature went up, then hands, legs, abdominal and back muscles gave up. I still could drag my feet, but very slowly and had to hold to something to stay upright. Later I was laying on a coach, pretty much unable to even change my position, just felt extremely weak. Somewhere around 10-12 hours after injection those effects started to ease up. None of the following injections caused such dramatic impact, just the very first one. *So, if you are put on any of these drugs, DO NOT go to work as I did, take a day off and stay home!* The experience of being carried up a stairs like a piece of furniture by other people was not a pleasant one. I suspect other people may have issues with sight, speech, memory or whatever other nerves and brain regions they got damaged by MS. Now I'm sort of afraid of getting sick, since it seems high temperature caused by anything makes me go very weak.
Yup, just do the first Kesimpta injection on Friday evening. In my case I was down entire Saturday and back to normal by Monday. No downtime from work.
@@blackspider4
My happened on Wednesday. I expected some trouble - I always get noticeably weaker the day after every flu shot or covid booster, I just did not expect my immune system to overreact to THAT degree.
Bonjour, je pense que ton neurologue n'as pas était "professionnel " sur la manière de prendre la 1ere injection ! Connaissant les effets mon neurologue m'a fait commencer un vendredi soir et il a bien fait 😅 il m'a fallu 2 jours pour récupérer ! Prenez soin de vous
This is an outstanding video! I’m currently on Rituximab and always wondered what my neurologist is looking for in the blood tests before each infusion. Thank you!
glad it helped.
Thank you for another informative video. I am on my fourth year of Rituxan, First year was every 6 months but after that went to 12 months due to low IGGs. I'm nervous as I go for bloodwork next week my IGG's get lower year.
This is the first time I've been on a Bcell depleting drug and I feel great! I hoping I don't have to switch!!
Would love for you to do a video about other DMTs that are as effective as Bcell depleting drugs.
Thankyou Dr,very informative video for those who are on immunosuppresent drugs
Thanks for the video Dr Brandon, excellent information .
No problem. Glad it helped.
Thanks, Brandon!
Thank you so much for sharing your knowledge! 🤩👋
:)
Thank you Doctor, seeing this video posted reminded me that I have to do blood tests for Kesimpta until Tuesday x)
Fantastic videos. Thank you! What labs would you do for mavenclad and is the risk related to this drug greater in an older population (without comorbidities) than a B cell depleter?
Thanks for that great video! I'm really glad that my doctor is checkin all the blood levels every 3 months. So far i doing great with OFA since 1,5 years and have even less infections (probably due to a strict sport routine, young age and edss 0)
Great video! I always wonder what they measure in my blood when they take it during my infusions. Tried to look at it on my patient profile, but way too complex for the layperson lol. Very informative, thanks!
Excellent!
Thanks Dr. Beaber, this info is very helpful to everyone on Ocrevus. I've been on Ocrevus since Sept 2022 and my doctor does all of those blood tests on me. I have seen my igM levels decline to below normal, but I haven't had any serious infections and remain on the standard 6 month interval. However, I did catch a cold a few days after my prior infusion and it seemed to linger for nearly a month. I suspect the Ocrevus circulating in my body made it harder for my immune system to fight back. Although my B cell count was 0 going into the infusion, so that may not be the case. My wife got it after me and kicked it in a week. I know everyone is different, but is there a time period range (years on Ocrevus) where most patients should extend time between doses or is it dependent on each individual's bloodwork (in that some never need to extend beyond standard dosing)?
Wow! What a great video! Well put together on covering a wide range of topics.
Thank you for all you do!
Thanks for the video suggestion.
Hello... Thank you for your efforts and interest regarding the treatment of ms , however, i suggest you make two types of videos ; one aimed to professionals and another aimed to those whom would probably start yawning 5 minutes into the video !! ....🌹👍
I don't think too many neurologists watch my videos.
It would be interesting/beneficial to see a comparison of pros/cons for RMS, comparing O, K, R, B. thank you.
Hi, thank you for the video. Been on Ocrevus for 3 years. Had COVID x3 times, 3rd time left me with Atrial Fibrillation (heart arrhythmia). I had Pneumonia back in Feb. Otherwise doing fine EDSS 0 38 years wise lol.
Thanks for this video! I'd like to ask, have you ever seen someone who had CD19 way below ref range prior 1st dose (no previous medication except high dose vit D /infections)?
Thank you for this great information, it's difficult to us, the patients to find these kind of information so well explained. I'm taking Ocrevus, doing so well in this drug, for me was a life changing to focus, memory and energy levels, even mood. I hope I can take this drug for long term.
I have a "singular" condition, say by hematologist, maybe due the autoinmune condition itself: i have more than normal levels of IGM (500 mg/dl) even after the treatment, but, they said that I don't have to worry about, it's a little weird for me understand the cause...
May I ask you a question? Do you concern about the simultaneous taking of ocrevus and isotretioin (acne treatment, in low level) by the effect on the liver the last may cause?
Thank you for your divulgative labour
Hi Dr. B
Thanks for this great information. I take Ocrevus and when I got diagnosed with RRMS last October, my EDSS was 3. Now I am EDSS 1 after six months.
I have a question: Is there a connection between mental psychiatric disorders and MS? I also have Asperger’s Syndrome (Autism level I).
Thanks
Thank you for this video! I’ve just started my 6th year of Rituxan. Last September, my doctor decided to do just one dose instead of the normal 2. In January my B-cells were still 0. I developed an Upper Respiratory Infection ( first infection in 6 years!). When my doc tested my B-cells again in February My CD19 B cells were normal and my CD20 B cells were high. This was the first time in 6 years the B cells were not zero. My doctor had me go back to 2 doses per round in March. I have experienced a lot of PIRA over the last year, I wonder if high Bcells could have contributed? I take Rituxan for both RA and MS.
is there any difference in the B cell depletion levels achived on rituxan vs Ocrevus?
Is there any difference in how long it takes for them to repopulate on average?
I su$pect not.
There may be a difference. From a review article on the topic: "Following rituximab administration in RA patients of either four weekly infusions of 375 mg/m2 or two 1,000 mg infusions two weeks apart, naïve B cells returned to baseline levels after 12-16 months" "Following ocrelizumab infusion, B cells returned to baseline or lower limits of normal in 90% of patients within 2.5 years of the last infusion. The median time for B cells to return to baseline was 72 weeks (range: 27-175 weeks) after the final infusion" Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC9246073/ Whether or not this translates to differences in clinical efficacy is not necessarily known, but clearly they are very similar.
Hi could you maybe do a video about taking two medications such as tecfidera for psoriasis and ocrevus for MS, as when I was on tecfidera my psoriasis cleared up but when I had to change to ocrevus, my psoriasis returned with a vengeance all over my body, and because I developed new lesions whilst on tecfidera It was advised to change
There is limited data on this. The CombiRx trial (copaxone + avonex vs. only copaxone or only avonex) showed combining medications was not helpful. I am not aware of specific data on ocrevus and tecfidera.
All of these doctors, including you keep saying talk to you on provider. My provider only has a total of five MS patients. 7000 patients total. He had heard of MS but that’s about it. He usually give you about 10 minutes of his time how you ask all this somebody that don’t even know about MS in 10 minutes dammit.
Is seeing a different neurologist an option?
Why do significant numbers of patients who took ocrevus loose their mobility?
Thanks for the video! I have two questions:
1) what causes the reaction with Ocrevus… is it the mode of getting the med or the fact that it’s killing B cells? My question stems from those who switch from O to K or vice versa … if those patients already have depleted B cells, theoretically are they statistically less likely to have that reaction since they have less CD20 B cells since they’ve been on a similar drug?
2) do you mind doing an in depth video like this on tysabri and the pill options that are similar to tysabri? I didn’t realize they worked similarly, and I would love to learn more! (The S word, sorry I cannot remember the word!)
Thank you!
Of course it is possible to have an allergic reaction to any drug, but infusion reactions from ocrevus are usually due to depletion of b-cells and release of their proinflammatory cytokines. When b-cells are already depleted, the risk of an infusion reaction is less. Here is a video on tysabri: czcams.com/video/LIKPYQFVNCQ/video.html Here is a video on the biosimilar tyruko: czcams.com/video/i6d-b6VTH5w/video.html
Thank you for sharing this video. I would like to share my experience. in Jun 2023,last year I got very bad pains in my eyes and more in left one. I visited one neurologist and I had MRI brain with lesions. but he said because I do not have any other symptoms ,this is migraine. In November 2023 I started more symptoms in my left and right foot and weakness of my leg left. I had MRI from spinal cord and it was two lesions , one at c3 and another at T6. but they did not prescribed medication as they were not sure it is MS. In January 2024 I got influenzas and after that many other symptoms came up such as burning and sensation, no sense in my legs , after 4 months now they said I have active MS and progressive MS and I have to take cladribine treatment. I rejected this treatment and I spoke to them to start Kesmpta injection and I am waiting for their reply by next week. I am not under any medication and every night I have burning and pain in my both legs.
Please advise me at this stage which treatment would be the best. Many Thanks
any thoughts on car T cell therapy for ms? considering entering a trial
I may do a video on this at some point
Ok cool. Could u give me a pov in the meantime? Kinda joking but also kinda hoping you’re like “do it” “it’ll be amazing”
when you say months after anti cd20 ur B's can come back exponentially I wonder is this not a kind of REBOUND? 9:00
They can "rebound" to levels slightly higher than baseline in some people, but unlike with some drugs such as gilenya and tysabri, this "rebound" is not associated with an increase in disease activity.
@@DrBrandonBeaber post hsct (7 months post Mexican hsct I am :
similar, better and worse (sic).
I am grateful for the work of Dr's like Beaber, Ruiz, Burt, Fedorenko and others yet, also, I am also of the opinion (or hunch really) that various truths, findings etc do overlap as per near infinite confounding factors. As they say 'god' (or Darwin's ghost) only knows .. I am looking forward to the next few years sans medical intervention to give my body a chance at self regulating. Although it has gone rogue on me with PPMS I have no doubt that it was an unintentional thing and that it still wants to help ME the organism. So far I've had the 1/2 doses of Ogrievous® and Cyclo-Ritux hsct. I'll give my ol sack of skin a chance without intervention, but simply, regular sleep exercise and happy days.
The current state is that the MS treatments in berlin germany hospitals are not happening reliably cause of "overload of patients" or the specific ms points were not reachable by phone. I think hospital ms point Neukölln has quitted collaboration cause they dont earn money with me. Berlin is saving money where they can. Brandenburg is not that extreme, but not where i live.
Love the explanation Doc, thanks for the reference chart as well 🤘🏻
#Sharingiscaring
- as a overly cautious #MavencladMIlF I still mask 😷 up in public places or in a crowd.
Sanitize like a mofo…( even wiping down public toilets 🚽 with Lysol wipes prior to layering with MASSIVE toilet paper 🧻)
It helps cut down infection risk ( IMO)
listening on 0.75 speed
:)
Same😂😂
The B cell depleters are a bad choice - they make PIRA worse.
What makes you say that?
Isn't it the opposite? 😅 I just started Kesimpta with almost no symptoms and EDSS 0, so it triggers my anxiety.😂
@@fragariasec Were you always at EDSS 0?
@@fragariasec Well you're very young and at EDSS 0 so I wouldn't worry.
yeah why do u say that?