Evaluating the Efficacy and Safety of Transitioning Patients From Natalizumab to Ocrelizumab

This is a multicenter, prospective, open-label, Phase IV clinical trial. Patients with
relapsing forms of Multiple Sclerosis (MS), ages 18 to 65, who have received 12 or more
continuous infusions of NTZ, and have been free of relapses, disability worsening or Magnetic
Resonance Imaging (MRI) progression 6 months prior to the transition screening visit will be
eligible for the study. After informed consent to participate has been obtained, the patient
will have physical exam (PE), non-blinded Expanded Disability Status Scale (EDSS), MRI,
Multiple Sclerosis Impact Scale (MSIS-29) and labs done for the screening visit to determine
eligibility. Brain MRI with and without contrast will be performed with the standard MS
protocol. MRIs will be performed with 3mm slice thickness with no gaps between slices.
Patients will receive their first dose of OCR 4 to 6 weeks after the last dose of NTZ. Other
baseline measures, including physical exam, EDSS, MSIS-29, and labs will be performed within
4 weeks of screening. Physical exam, non-blinded EDSS, and labs will be performed at month 3,
month 6, month 9, and month 12. MSIS-29 will be performed at months 6 and 12. In addition,
MRIs will be performed at months 3, 6, and 12.

Inclusion Criteria:

- Able to understand the purpose and risk of the study and provide signed informed
consent document.

- Must have received 12 or more consecutive monthly infusions of NTZ, and have had no
evidence of on-NTZ disease activity (clinically or on MRI) for the 6 months prior to
the screening visit.

- Naïve to OCR.

- No evidence, in the opinion of the investigators of significant cognitive limitation
or psychiatric disorder that would interfere with the conduct of the study.

- EDSS of ≤ 6.0 at screening.

- Female patients of childbearing potential must practice effective contraception and
continue contraception during the study.

Exclusion Criteria:

- History of primary or secondary progressive multiple sclerosis.

- Any mental condition of such that patient is unable to understand the nature, scope,
and possible consequences of the study.

- Patients with a known history of hepatitis B, hepatitis C, tuberculosis, PML, or who
are HIV positive.

- Any persistent or severe infection.

- Any malignancy within 5 years, except for basal or squamous cell skin lesions, which
have been surgically excised, with no evidence of metastasis.

- Pregnancy or lactation.

- Significant or uncontrolled somatic disease or severe depression in the last year.

- Inability to complete an MRI.

- Previous treatment with B-cell targeted therapies.

- Current use of immunosuppressive medication.

- Patients who have had evidence of disease activity within the 6 months prior to
screening. This includes MS relapse, or new or enlarging T2 lesions or Gd+ enhancing
lesions, or disability progression.

- Patients with any significant comorbidity that in the opinion of the investigator,
would interfere with participation in the study.