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Tysabri vs Ocrevus for MS: What’s The Difference?

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Key differences and similarities between two of the more well-known infused medications for MS: Tysabri and Ocrevus.

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, leading to nerve damage, disability, and a range of physical and mental symptoms. 

MS can cause muscle weakness, spasticity, balance problems, fatigue, pain, and cognitive impairment, among other challenges. While there is no cure for MS, various treatments can help manage symptoms and improve quality of life. Two of the more well-known infused medications include Tysabri and Ocrevus. Below, we break down the key differences and similarities between the two, including:

  • How each medication works
  • Eligibility
  • Administration & dosage
  • Potential side effects


What is Tysabri

Tysabri (natalizumab) is in a class of medications known as immunomodulators and is an immunosuppressive. As a monoclonal antibody, it may help prevent worsening symptoms or slow the progression of disability for patients with relapsing-remitting multiple sclerosis (RRMS) or those with moderate to severe Crohn’s disease. 

In cases of relapsing multiple sclerosis, blood cells which produce antibodies (B cells) and blood cells that provide defense against viruses and bacteria (T cells) enter the central nervous system. These lymphocytes attack nerves, leading to numbing, tingling, muscle fatigue or weakness, vision problems, and loss of bowel or bladder control. Relapsing-remitting multiple sclerosis is identified by immune system flare-ups, or relapses, of the disease.

Tysabri works by targeting and attaching to a protein called integrin; the treatment is designed to block cells from launching an inflammatory attack on the brain or spinal cord, where damage to nerve cells can occur.

Who can take Tysabri

Tysabri may be an effective treatment for patients 18 years of age and older with relapsing MS or those with moderate to severe Crohn’s disease. Tysabri may be considered for those who have not responded to other medications, when medication cannot be taken by mouth, or when stomach acid impacts oral prescriptions.

Patients must be enrolled in and meet criteria for the TOUCH® Prescribing Program.

Administration and dosage of Tysabri

Tysabri is only available through a distribution program called the MS TOUCH® Prescribing Program. Only prescribers, infusion centers such as Local Infusion, and pharmacies associated with infusion centers registered with the program may prescribe and distribute the product.

A healthcare professional administers Tysabri as a 300mg intravenous infusion (IV infusion) for one hour every four weeks. Patients are advised to stay in the clinic for an additional 60 minutes for routine observation.

Tysabri begins working after the first dose; however, many patients feel the beneficial effects within 12 weeks.

Potential side effects

Biogen, the manufacturer of Tysabri, cautions that long-term treatment, especially over two years, may increase the risk of progressive multifocal leukoencephalopathy (PML), a rare viral brain infection that can lead to severe disability. 

Only those who have been infected by the John Cunningham Virus (JCV) can develop PML, but it is important to understand that testing positive for the John Cunningham virus antibody does not mean PML will develop. The estimated risk of developing PML is less than 1%.

Prior to receiving Tysabri or while receiving treatments, a doctor may order blood tests to ensure blood cells have not been infected by JCV.

Other adverse events may include:

  • Herpes infections, encephalitis, or meningitis
  • Liver damage, nausea, fatigue, vomiting
  • Allergic reactions (hives, itching, trouble breathing)
  • Low platelet counts, bruising of the skin, bleeding that is hard to stop
  • Urinary tract infection, vaginitis, respiratory tract infection, or other opportunistic infections occurring in people with weakened immune systems
  • Headache, joint pain, depression, diarrhea

Patients considering Tysabri treatment should discuss the potential benefits and side effects with their physician. Refer to the FDA-approved Prescribing Information (PI) for safety and effectiveness information.

Suspected adverse reactions can be reported directly to Biogen or the FDA Safety Information and Adverse Event Reporting Program at 1-888-463-6332.


What is Ocrevus

Ocrevus (ocrelizumab) is a monoclonal antibody designed to target B lymphocytes. Although a vital part of our immune system, these white blood cells can contribute to nerve damage in patients with multiple sclerosis (MS) by attacking the myelin that surrounds the nerves in the brain.

Ocrevus is prescribed for the treatment of relapsing forms of multiple sclerosis including relapsing-remitting disease (RRMS) and active secondary progressive disease (SPMS). This disease-modifying therapy is the only FDA-approved treatment for those with primary progressive multiple sclerosis (PPMS).

In clinical trials, Ocrevus was proven effective in significantly lowering the relapse rate, slowing the progression of disability, and reducing brain lesions in patients with RMS compared to those receiving Rebif® (interferon beta-1a).

For those diagnosed with primary progressive multiple sclerosis (PPMS), Ocrevus was proven effective in slowing disability progression and reducing brain lesions compared to those receiving a placebo.

Who can take Ocrevus

Ocrevus (ocrelizumab) may be an effective treatment for patients 18 years of age and older with relapsing forms of multiple sclerosis (MS), including:

  • Clinically-isolated syndrome
  • Relapsing-remitting disease
  • Active secondary progressive disease

This medication is also used to treat primary progressive MS in adults. It may be suitable for patients beginning treatment for MS as well as those switching from other medications.

Ocrevus should not be received by patients with active hepatitis B (HBV) or those who have had an allergic reaction to Ocrevus or any of its ingredients.

Administration and dosage of Ocrevus

Ocrevus is administered intravenously at an infusion center, doctor’s office, or home. The initial dose is received in two infusions of 300 mg, spaced two weeks apart. Subsequent doses of 600 mg are administered every six months.

Patients can expect initial treatments to take 2.5 hours or longer in duration, depending on the infusion rate. Subsequent doses can range from two hours to 3.5 hours.

Post-infusion, patients will be monitored for at least one hour for any side effects or symptoms of an infusion reaction.

Potential side effects

Common side effects and infusion reactions may include:

  • Itchy skin/rash/hives
  • Tiredness/feeling faint/dizziness/fatigue
  • Coughing/wheezing/trouble breathing/shortness of breath
  • Throat irritation or pain/swelling of the throat
  • Fever/redness on the face (flushed)
  • Nausea/headache
  • Rapid heart beat

Rare, serious infections may include: 

  • Upper respiratory tract infection
  • Lower respiratory tract infection
  • Skin infections
  • Herpes infections
  • Hepatitis B Virus (HBV) reactivation
  • Weakened immune system
  • PML

Neurology signs and symptoms that should be reported to your healthcare provider include changes in thinking, eyesight, strength, balance, weakness on one side, or use of arms and legs.

How to select the proper MS treatment

Disease-modifying therapies are prescribed to modify or influence the underlying course of relapsing forms of MS. Various immunomodulatory therapies, as indicated below, work to target the inflammatory process, reduce relapse rates, slow the progression of the disease, and ease MS-related symptoms.

Injectable medications

  • Interferon beta-1a
  • Glatiramer acetate

Oral medications

  • Fingolimod
  • Cladribine
  • Dimethyl fumarate
  • Teriflunomide

Infused medications

  • Tysabri (natalizumab)
  • Ocrevus (ocrelizumab)
  • Lemtrada (alemtuzumab)
  • Briumvi (ublituximab-xiiy) — just approved by the FDA in January 2023 and offered at Local Infusion.

With so many treatment choices available, MS patients should seek the medical advice of a healthcare professional to evaluate the benefits, risks, potential side effects, and impact of treatments on daily life. Together with your doctor, you’ll be able to make the most informed decision to help achieve your wellness goals.

The bottom line

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