With all of the new Multiple Sclerosis (MS) drugs available, it can be confusing on which one to choose. Of course, your doctor will help navigate you, but it is always good to understand the choices and be armed with questions to make the most of your doctor’s visit.
Ocrevus came onto the market in 2017 and has remained one of the more popular choices for patients with both relapsing and primary progressive MS. In fact, it remains the only drug approved for primary progressive MS.
Kesimpta came onto the market in 2020. Both Ocrevus and Kesimpta target CD20 on B cells (a type of white cell in the immune system) to deplete or reduce B cells in MS patients. B cells are the target for MS treatments because B cells can enter the brain and spinal cord, triggering inflammation and attacking the protective coating of the nerves -called myelin. Damage to myelin is the hallmark of MS flares. Reducing this damage reduces relapses and slows disease progression. CD20 is a protein that is on the surface of B cells. While the exact function of CD20 is unknown, it is thought to contribute to B cell activation and proliferation.
So, if both Ocrevus and Kesimpta target CD20 on B cells, which one is better? That answer often comes down to personal preference. See the chart below that highlights the differences.
Comparison Table
| Feature | Kesimpta (Ofatumumab) | Ocrevus (Ocrelizumab) | Ocrevus Zunovo (Ocrelizumab & Hyaluronidase) |
| Drug Class | Monoclonal antibody targeting CD20 B-cells (fully human) | Monoclonal antibody targeting CD20 B-cells (humanized) |
Monoclonal antibody targeting CD20 B-cells (humanized) |
| Mechanism | Depletes circulating B-cells to reduce inflammation and MS activity | Depletes B-cells to reduce immune-mediated damage in MS |
Depletes B-cells to reduce immune-driven inflammation and tissue injury in MS |
| MS Types Approved For | Relapsing forms of MS (RRMS, active SPMS, CIS) | Relapsing forms of MS and Primary Progressive MS (PPMS) |
Relapsing forms of MS and Primary Progressive MS (PPMS) |
| Where Given | Self-injection at home | Infusion center or clinic |
Clinic setting as a subcutaneous injection |
| Onset of Effect | Usually within a few months | Typically 1-3 months after first infusion |
Clinical and MRI benefits generally begin within the first 1–3 months, similar to IV ocrelizumab |
| Monitoring Needs | Less frequent; watch for injection & immunoglobulin levels | Infusion-related reaction monitoring during/after each dose |
Observation for injection-related reactions during/after each dose; hepatitis B screening before starting; periodic immunoglobulin checks; monitor for signs of infection |
| Common Side Effects | Injection-site reactions, upper respiratory infections, headache, fatigue | Infusion reactions (rash, itching, throat irritation), infections, fatigue |
Injection-site reactions (redness, swelling, pain, itching), upper respiratory infections, fatigue |
| Serious Risks | Infection risk, low IgG levels (over time), hepatitis B reactivation | Infusion reactions, infection risk, possible malignancy signal (breast cancer), hepatitis B reactivation |
Injection reactions, infection risk, possible malignancy signal, hepatitis B reactivation, rare PML, immune-mediated colitis |
| Administration Route | Subcutaneous injection (auto-injector pen) | Intravenous infusion (IV, in clinic); subcutaneous form emerging |
Subcutaneous injection (in clinic) |
| Dosing Schedule | Weekly for first 3 weeks then once monthly | Two 300 mg doses 2 weeks apart then 600 mg every 6 months |
Single 600 mg subcutaneous dose every 6 months (no loading doses for Zunovo) |
Clearly, the choice is different for everyone. Certainly, if you have Primary Progressive MS, Ocrevus is the choice for you. If you prefer home self-injections even though they are more frequent, then Kesimpta is the clear choice. Look the chart over carefully, take notes, and discuss with your physician.
BeCare MS can help you, by monitoring for disease progression, by offering educational materials and an AI assistant to help you work through your concerns, and with our community of MS patients who can share their experiences and opinions. Be empowered. Be a driver in your own MS journey.