Formulary restrictions:

• Indication: treatment of relapsing multiple sclerosis (MS)
• Service line: Neurology
• Formulary location: Outpatient infusion
• Service location: Outpatient infusion, home infusion
• Patient population: Adults (≥18 years)
• Prior authorization required: Yes
• Restriction/criteria of use (all will apply unless specified):
  • Not concomitantly receiving other disease modifying therapies for MS
  • No active Hepatitis B Virus infection
  • Pregnancy testing is recommended for females of reproductive potential prior to each infusion.
    • Females of reproductive potential should use effective contraception while receiving ublituximab-xiiy (Briumvi) and for 6 months after the last dose of ublituximab-xiiy (Briumvi)
  • Require testing for quantitative serum immunoglobulins
  • All immunizations administered according to immunization guidelines at least 4 weeks prior to initiation of ublituximab-xiiy (Briumvi) for live or live-attenuated vaccines and, whenever possible, at least 2 weeks prior to initiation of ublituximab-xiiy (Briumvi) for non-live vaccines

NOTE:

• Ublituximab-xiiy (Briumvi) is OH preferred over ocrelizumab (Ocrevus) in the treatment of relapsing MS.
• Ocrevus is currently the only FDA-approved treatment of primary progressive MS.

• UpToDate
• Lexicomp
• DailyMed Package Inserts
• Johns Hopkins Guides