Drug Interactions between cholera vaccine and ocrelizumab

MONITOR: The administration of inactivated, killed, or otherwise noninfectious vaccines to immunosuppressed patients is generally safe but may be associated with a diminished or suboptimal immunologic response due to antibody inhibition. In a study in adults aged 18 to 55 years with relapsing forms of multiple sclerosis (MS), vaccination with several non-live vaccines in 68 subjects receiving ocrelizumab at the time of vaccination and 34 subjects not receiving ocrelizumab, revealed attenuated antibody titers in those receiving treatment with ocrelizumab. The vaccines tested included tetanus toxoid-containing vaccine, pneumococcal polysaccharide, pneumococcal conjugate vaccines, and seasonal inactivated influenza vaccines. Additionally, because therapy with ocrelizumab causes a depletion of B-cells, a decrease or suboptimal immunologic vaccine response may be expected if immunization occurs before B-cells counts have recovered. Pharmacodynamic data has shown the median time to B-cell repletion following discontinuation of ocrelizumab is 72 weeks (range 27 to 175 weeks). For infants of mothers who have been exposed to ocrelizumab during pregnancy, there is a potential for depletion of B cells in their infants.

MANAGEMENT: Ocrelizumab therapy may interfere with the effectiveness of non-live vaccines. The immunization status of patients should be reviewed prior to initiating therapy with ocrelizumab and recommended immunizations with non-live vaccines completed at least 2 weeks prior to initiating therapy (some authorities have recommended at least 6 weeks). Annual influenza vaccines are recommended for patients being treated with ocrelizumab. For infants of mothers exposed to ocrelizumab during pregnancy, non-live vaccines may be administered as indicated, however, adequacy of vaccine response should be assessed; this may include a consultation with a qualified specialist or measurement of vaccine-induced response titers to verify that a protective immune response has been mounted.