Ocrelizumab: Leading the Charge in MS Relapse Management

In the dynamic landscape of multiple sclerosis (MS), managing relapses represents an ever-present challenge, as reflected in major society recommendations for disease-modifying therapy in relapsing forms of MS. Ocrelizumab is carving out its place as a pivotal player in this arena, promising renewed hope for those affected by this neurological condition.

The immune-modulating effects of ocrelizumab, which target CD20-positive B cells, have shown promising results in reducing the frequency of MS relapses. This mechanism may have neuroprotective effects—a hypothesis under investigation—while its primary impact is on inflammatory disease activity.

Ocrelizumab’s ability to target CD20-positive B cells not only curtails relapses but is also associated with sustained control of disease activity over time in pivotal phase 3 programs such as OPERA I/II and their extensions. Its efficacy data and inclusion in major society recommendations support an established role in MS management strategies.

Exploring emerging opportunities, ocrelizumab is now being evaluated for innovative administration routes, such as subcutaneous dosing, paving the way for more flexible treatment options. These advancements are discussed in an overview of dosing innovations. By contrast, extended-interval dosing—spacing infusions beyond the standard 6-month interval—has observational support suggesting maintained relapse and MRI control in selected patients.

Furthermore, extending infusions beyond the standard 6-month interval (extended-interval dosing) has been explored in observational practice, with reports of maintained relapse rates and MRI activity in appropriately selected patients, potentially improving convenience for some.

The advances represented by ocrelizumab point toward a future in which more tailored MS therapies may improve day-to-day functioning for many patients. At the same time, treatment decisions should balance benefits with known risks—such as infusion reactions, infections, and hypogammaglobulinemia—and incorporate appropriate monitoring.

Key takeaways:

• Comparative effectiveness: Observational, multi-registry analyses presented at ECTRIMS 2025 suggest lower relapse rates and less MRI activity with ocrelizumab versus some alternatives, while recognizing these are not head-to-head randomized trials.
• Dosing innovations: Subcutaneous administration is under evaluation, and extended-interval dosing has emerging observational support; evidence maturity differs across these approaches.
• Personalization and safety: Treatment selection should consider patient-specific factors alongside safety and monitoring for risks such as infusion reactions, infections, and hypogammaglobulinemia.