• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor.
• If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. See section 4.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.

1. What Ocrevus is and what it is used for
2. What you need to know before you are given Ocrevus
3. How Ocrevus is given
4. Possible side effects
5. How to store Ocrevus
6. Contents of the pack and other information

Ocrevus contains the active substance ‘ocrelizumab’. It is a type of protein called a ‘monoclonal antibody’. Antibodies work by attaching to specific targets in your body.

Ocrevus is used to treat adults with:

• Relapsing forms of multiple sclerosis (RMS)
• Early primary progressive multiple sclerosis (PPMS)

Multiple Sclerosis (MS) affects the central nervous system, especially the nerves in the brain and spinal cord. In MS, the immune system (the body’s defence system) works incorrectly and attacks a protective layer (called myelin sheath) around nerve cells and causes inflammation. Breakdown of the myelin sheath stops the nerves working properly.

Symptoms of MS depend on which part of the central nervous system is affected and can include problems with walking and balance, weakness, numbness, double vision and blurring, poor coordination and bladder problems.

• In relapsing forms of MS, the patient has repeated attacks of symptoms (relapses). The symptoms can appear suddenly within a few hours, or slowly over several days. The symptoms disappear or improve between relapses but damage may build up and lead to permanent disability.
• In primary progressive MS, the symptoms generally continue to worsen from the start of the disease.

Ocrevus attaches to specific B cells, which are a type of white blood cells that are part of the immune system and play a role in MS. Ocrevus targets and removes those specific B cells. This reduces inflammation and attacks on the myelin sheath, reduces the chance of having a relapse and slows the progression of your disease.

• In Relapsing forms of MS (RMS), Ocrevus helps to significantly reduce the number of attacks (relapses) and significantly slow down the progression of the disease. Ocrevus also significantly increases the chance of a patient having no evidence of disease activity (brain lesions, relapses and worsening of disability).
• In Primary Progressive MS (PPMS), Ocrevus helps to slow down the progression of the disease and reduce deterioration in walking speed.

• if you are allergic to ocrelizumab or any of the other ingredients of this medicine (listed in section 6).
• if you currently have an infection.
• if you have been told that you have severe problems with your immune system.
• if you have cancer.

If you are not sure, talk to your doctor before you are given Ocrevus.

Talk to your doctor before you are given Ocrevus if any of the following apply to you. Your doctor may decide to delay your treatment with Ocrevus, or may decide you cannot receive Ocrevus if:

• you have an infection. Your doctor will wait until the infection is resolved before giving you Ocrevus.
• you have ever had hepatitis B or are a carrier of the hepatitis B virus. This is because medicines like Ocrevus can cause the hepatitis B virus to become active again. Before your Ocrevus treatment, your doctor will check if you are at risk of hepatitis B infection. Patients who have had hepatitis B or are carriers of the hepatitis B virus will have a blood test and will be monitored by a doctor for signs of hepatitis B infection.
• you have cancer or if you have had cancer in the past. Your doctor may decide to delay your treatment with Ocrevus.

• Diseases that affect your immune system: if you have another disease which affects the immune system. You may not be able to receive Ocrevus.
• Medicines that affect your immune system: if you have ever taken, are taking or are planning to take medicines that affect the immune system – such as chemotherapy, immunosuppressants or other medicines used to treat MS. Your doctor may decide to delay your treatment with Ocrevus or may ask you to stop such medicines before starting treatment with Ocrevus. See under ‘Other medicines and Ocrevus’, below for more information.

• Injection reactions are the most common side effect of Ocrevus treatment given as an injection under your skin (subcutaneous injection).
• Tell your doctor or nurse straight away if you have any injection reaction (see section 4 for a list of injection reactions). Injection reactions can happen during the injection or up to 24 hours after the injection.
• To reduce the risk of injection reactions, your doctor will give you other medicines before each injection of Ocrevus (see section 3) and you will be observed during the injection and for at least one hour after the initial injection has been given.

• Talk to your doctor before you are given Ocrevus if you think you have an infection. Your doctor will wait until the infection is resolved before giving you Ocrevus.
• You might get infections more easily with Ocrevus. This is because the immune cells that Ocrevus targets also help to fight infection.
• Before you start treatment with Ocrevus and before subsequent injections, your doctor may ask you to have a blood test to verify your immune system because infections may occur more frequently in case of severe problems with your immune system.
• If you are treated with Ocrevus for primary progressive multiple sclerosis, and you have swallowing difficulties, Ocrevus may increase the risk of severe pneumonia.
• Tell your doctor or nurse straight away if you have any of these signs of infection during or after Ocrevus treatment:
  • fever or chills
  • cough that does not go away
  • herpes (such as cold sore, shingles or genital sores).
• Tell your doctor or nurse straight away if you think your MS is getting worse or if you notice any new symptoms. This is because of a very rare and life-threatening brain infection, called ‘progressive multifocal leukoencephalopathy’ (PML), which can cause symptoms similar to those of MS. PML can occur in patients taking Ocrevus.
  Tell your partner or carer about your Ocrevus treatment. They might notice symptoms of PML that you do not, such as memory lapses, trouble thinking, difficulty walking, sight loss, changes in the way you talk, which your doctor may need to investigate.

• Tell your doctor if you have recently been given any vaccine or might be given a vaccine in the near future.
• While you are being treated with Ocrevus, you should not be given live or live attenuated vaccines (for example BCG for tuberculosis or vaccines against yellow fever).
• Your doctor may recommend that you are given a seasonal influenza vaccine.
• Your doctor will check if you need any vaccinations before you start treatment with Ocrevus. Any vaccinations should be given at least 6 weeks before you start treatment with Ocrevus.

Ocrevus is not intended to be used in children and adolescents under 18 years old. This is because it has not yet been studied in this age group.

Tell your doctor if you are taking, have recently taken or might take any other medicines.

In particular tell your doctor if:

• you have ever taken, are taking or are planning to take medicines that affect the immune system – such as chemotherapy, immunosuppressants or other medicines used to treat MS. The effect on the immune system of these medicines with Ocrevus could be too strong. Your doctor may decide to delay your treatment with Ocrevus or may ask you to stop such medicines before starting treatment with Ocrevus.

If any of the above apply to you (or you are not sure), talk to your doctor before you are given Ocrevus.

• If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. This is because Ocrevus may cross the placenta and affect your baby.
• Do not use Ocrevus if you are pregnant unless you have discussed this with your doctor. Your doctor will consider the benefit of you taking Ocrevus against the risk to your baby.
• Talk to your doctor before vaccinating your baby.

Women who could become pregnant must use contraception:

• during treatment with Ocrevus and
• for 12 months after your last dose of Ocrevus.

Do not breast-feed while you are being treated with Ocrevus. This is because Ocrevus may pass into breast milk.

It is not known whether Ocrevus can affect your ability to drive or use tools or machines.

Your doctor will tell you whether your MS may affect your ability to drive or use tools and machines safely.

This medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially ‘sodium-free’.

Before you are given Ocrevus, you will receive other medicines to prevent or reduce possible side effects such as injection reactions (see sections 2 and 4 for information about injection reactions).

You will receive a corticosteroid and an anti-histamine before each injection and you may also receive medicines to reduce fever.

You will be given a total dose of 920 mg of Ocrevus every 6 months.

• Ocrevus will be given to you by a doctor or a nurse. It will be given as an injection under your skin (subcutaneous injection).
• Injections will be given in the stomach in approximately 10 minutes.
• Your doctor or nurse will make sure each injection is given in the stomach, where the skin is not red, bruised, tender, hard, or areas where there are moles or scars.
• You will be observed while you are being given Ocrevus and for at least 1 hour after the initial injection has been given. This is in case you have any side effects such as injection reactions. The injection may be temporarily stopped or permanently stopped if you have an injection reaction, depending on how serious it is (see sections 2 and 4 for information about injection reactions).

• If you miss an injection of Ocrevus, talk to your doctor to arrange to have it as soon as possible. Do not wait until your next planned injection.
• To get the full benefit of Ocrevus, it is important that you receive each injection when it is due.

• It is important to continue your treatment for as long as you and your doctor decide that it is helping you.
• Some side effects can be related to having low B cells. After you stop Ocrevus treatment, you may still experience side effects until your B-cells return to normal. Your blood B-cells will gradually increase to normal levels. This can take from six months to two and a half years, or up to several years in rare cases.
• Before you start any other medicines, tell your doctor when you had your last Ocrevus dose.

Injection reactions

• Injection reactions are the most common side effect of Ocrevus treatment given as a subcutaneous injection (very common: may affect more than 1 in 10 people). In most cases these are mild or moderate reactions but serious reactions have happened with Ocrevus treatment given as an infusion in a vein (intravenous infusion).
• Tell your doctor or nurse straight away if you experience any signs or symptoms of an injection reaction during the injection or up to 24 hours after the injection. Symptoms can include, but are not limited to:
  • itchy skin
  • rash
  • hives
  • redness of the skin
  • throat irritation or pain
  • shortness of breath
  • swelling of the throat
  • flushing
  • low blood pressure
  • fever
  • feeling tired
  • headache
  • feeling dizzy
  • feeling sick (nausea)
  • fast heart beat.
• If you have an injection reaction, you may be given medicines to treat it and the injection may need to be stopped. If the injection reaction is life-threatening, your doctor will permanently stop your treatment with Ocrevus.

Infections

• You might get infections more easily with Ocrevus. The following infections have been seen in patients treated with Ocrevus in MS:
  • Very common (may affect more than 1 in 10 people)
    • sore throat and runny nose (upper respiratory tract infection)
    • flu
  • Common (may affect up to 1 in 10 people)
    • sinus infection
    • bronchitis (bronchial tube inflammation)
    • herpes infection (cold sore or shingles)
    • infection of the stomach and bowel (gastroenteritis)
    • respiratory tract infection
    • viral infection
    • skin infection (cellulitis)

Some of them might be serious.

• Tell your doctor or nurse straight away if you notice any of these signs of infection:
  • fever or chills
  • cough which does not go away
  • herpes (such as cold sore, shingles and genital sores)

Very common (may affect more than 1 in 10 people)

• decrease in specific proteins in the blood (immunoglobulins) which help protect against infection

Common (may affect up to 1 in 10 people)

• discharge from the eye with itching, redness and swelling (conjunctivitis)
• cough
• a build-up of thick mucus in the nose, throat or chest
• low levels of a type of white blood cell (neutropenia)

Not known (it is not known how often these side effects happen)

• a reduction in white blood cells which can be delayed

If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

• The active substance is ocrelizumab. Each vial contains 920 mg of ocrelizumab in 23 mL at a concentration of 40 mg/mL.
• The other ingredients are recombinant human hyaluronidase (rHuPH20), sodium acetate trihydrate (see Section 2 ‘Ocrevus contains sodium’), glacial acetic acid, α,α-trehalose dihydrate, polysorbate 20, L-methionine and water for injections.

• Ocrevus is a clear to slightly opalescent, and colourless to pale brown solution.
• It is supplied as a solution for injection.
• Ocrevus is available in a pack containing 1 glass vial.