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Ocrevus vs Aubagio: How do they compare for MS?

Medically reviewed by Melisa Puckey, BPharm. Last updated on Sep 28, 2021.

Official answer

by Drugs.com
  • Ocrevus and Aubagio are both used to treat relapsing forms of multiple sclerosis (RMS) including clinically isolated syndrome, relapsing-remitting disease and active secondary progressive disease.
  • Ocrevus is also used to treat primary progressive multiple sclerosis (PPMS).
  • Aubagio is an immunomodulatory agent with anti-inflammatory properties.
  • Ocrevus is a CD20 monoclonal antibody.


How well does each medication work?

There have been clinical trials for Ocrevus (ocrelizumab) and clinical trials for Aubagio (teriflunomide), but no head to head trials comparing both medicines, could be found.

PPMS clinical trial with Ocrevus:
In a 120 week randomized, double-blind, placebo-controlled clinical trial:

  • The Ocrevus patients were less likely to have a 12-week confirmed disability progression when compared to placebo.
  • The Ocrevus group had a smaller percentage of patients that had a slower timed of 25-foot walk at 12 weeks of treatment, compared to the placebo group patients.


RMS separate clinical trials for Ocrevus and Aubagio:

Both medicines extended the time patients were relapse free:

  • The proportion of Ocrevus patients that were relapse free at week 96 were 83% . Dose 600 mg every 24 weeks after initial treatment.
  • The proportion of Aubagio patients that were relapse free at week 108 were, Aubagio 7mg 53.7%, Aubagio 14mg 56.6% and Placebo 45.6%.

Both medicines had less patients who had disability progression that was sustained over 12 weeks.

  • For the Ocrevus trial at 96 weeks the proportion of patients with 12-week confirmed disability progression was 9.8% (600 mg every 24 weeks after initial treatment).
  • For the Aubagio trial at week 108 the percentage patients with disability progression sustained for 12 weeks in were, placebo 27.3%, Aubagio 7mg 21.7% and Aubagio 14mg 20.2%.


How easy are they to take?

Aubagio is taken:

  • as an oral tablet
  • 7mg and 14mg
  • daily with or without food

Ocrevus is taken:

  • as an IV infusion
  • initial treatment is two 300mg IV infusions 2 weeks apart, then 600mg IV every 24 week

How safe are they?

Aubagio has Boxed Warnings, specifically warning people that taking Aubagio can cause

  • liver damage, which can be clinically significant and potentially life threatening.
  • fetal harm, which means if you are pregnant your baby may be harmed if you take Aubagio. More information about pregnancy below.

Ocrevus does not have a Boxed Warning.


Pregnancy

Both medicines should not be taken if planning a pregnancy or if you are pregnant

Aubagio: You should not get pregnant while on this medicine. After being on Aubagio women planning to become pregnant must wait until their blood levels are below 0.02mg/L. Men should not get their partners pregnant while on Aubagio, and when they stopped treatment they need to wait until their blood levels are below 0.02mg/L. Women should not breastfeed while being treated with this medicine.

Ocrevus: Women should not get pregnant while on Ocrevus and should not get pregnant for a further 6 months after having the last infusion.


Who should not take these medications?

Some people should not take some medications if they have been or are on specific medications or have a particular health condition, these are called contraindications.

You should not take Aubagio if you:

  • are a woman who is pregnant, or a man or woman who is planning to become pregnant
  • have severe hepatic impairment
  • have a history of a hypersensitivity reaction to teriflunomide, leflunomide, or to any of the inactive ingredients in Aubagio.
  • if you take leflunomide.

You should not take Ocrevus if you:

  • are a woman who is pregnant
  • have Hepatitis B virus (HBV)
  • have a history of life-threatening infusion reaction to Ocrevus

What serious side effects does each medicine have?

Aubagio: hepatotoxicity, bone marrow effects, immunosuppression, potential infections, hypersensitivity reactions, serious skin reactions, drug reaction with eosinophilia and systemic symptoms, peripheral neuropathy, increased blood pressure, respiratory effects, pancreatitis in pediatric patient
Ocrevus: infusion reactions, increased risk of infections, reduction in immunoglobulins, malignancies.

Table Comparing Aubagio and Ocrevus

Ocrevus (ocrelizumab ) Aubagio ( teriflunomide)
Boxed Warning None Yes, Hepatotoxicity and Embryofetal toxicity
Indications (adults) Primary Progressive MS
Relapsing forms of MS including clinically isolated syndrome, relapsing-remitting disease and active secondary progressive disease
Relapsing forms of MS including clinically isolated syndrome, relapsing-remitting disease and active secondary progressive disease
Medicine Group CD monoclonal antibody Immunomodulatory disease modifying therapy (DMT)
Medication Form IV infusion Oral tablet
Dose Initially: 300 mg IV followed 2 weeks later by a second 300 mg IV infusion.
Then maintenance dose of 600mg IV every 6 months

7 mg or 14 mg tablet
Taken once daily
Aubagio can be taken with or without food

Pregnancy Women should not get pregnant while on Aubagio and should not get pregnant for 6 months after their last infusion Women should not get pregnant while on Aubagio and after until their blood levels are less than 0.02 mg/L
Men should not get their partners pregnant while on Aubagio and after until blood levels are less than 0.02 mg/L
Women should not breastfeed during treatment with Aubagio.
Contraindications Pregnancy
Hepatitis B virus (HBV)
A history of life-threatening infusion reaction to Ocrevus
Pregnancy (Aubagio may cause fetal harm)
Patients with severe hepatic impairment
Patients with a history of a hypersensitivity reaction to teriflunomide, leflunomide, or to any of the inactive ingredients in Aubagio.
Should not be taken with leflunomide.
Serious Side Effects Infusion Reactions
Increased risk of infections
Reduction in Immunoglobulins
Malignancies
Hepatotoxicity
Bone Marrow Effects/Immunosuppression Potential/Infections
Hypersensitivity Reactions
Serious Skin Reactions
Drug Reaction with Eosinophilia and Systemic Symptoms
Peripheral Neuropathy
Increased Blood Pressure
Respiratory Effects
Pancreatitis in Pediatric Patients
Effectiveness

RMS (600 mg every 24 weeks after initial treatment)
The proportion of patients that were relapse free at week 96 were: 83%
At 96 weeks the proportion of patients with 12-week confirmed disability progression was: 9.8%


PPMS (600 mg every 24 weeks after initial treatment)
Proportion of patients with 12-week confirmed disability progression:
Ocrevus 32.9%
Placebo 39.3%
Decrease by 20 % of timed 25-foot walk at 12 weeks:
Ocrevus 49%
Placebo 59%

RMS
The percentage of patients that were relapse free at week 108 were:
Placebo 45.6%
Aubagio 7mg 53.7%
Aubagio 14mg 56.6%
The percentage of patients with sustained disability progression for 12 weeks were:
Placebo 27.3%
Aubagio 7mg 21.7%
Aubagio 14mg 20.2%



Bottom line:

  • Ocrevus and Aubagio are both used to treat relapsing forms of multiple sclerosis and active secondary progressive disease. Ocrevus is also used to treat primary progressive multiple sclerosis.
  • In clinical trials for RMS both medicines extended the time patients were relapse free and had less patients who had disability progression that was sustained over 12 weeks.
  • In clinical trials for PPMS Ocrevus were less likely to have a 12-week confirmed disability progression when compared to placebo. Ocrevus patients had a smaller percentage of patients that had a slower timed of 25-foot walk at 12 weeks of treatment.
  • Individual patients' contraindications, other medications and medical conditions will determine which medication will suit them best.
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