ORIGINAL RESEARCH article
Front. Immunol.
Sec. Multiple Sclerosis and Neuroimmunology
Dermatological and gastrointestinal adverse reactions in ocrelizumab treated patients with multiple sclerosis: a case series
Provisionally accepted
Lena Höpner1
Ella Marschall1
Patrick Schindler1Vilmar Frauendorf2
Michael Böhmig3
Florian Rakers4Diana Karimi5Claudius Faber5Klemens Ruprecht6
Carolin Otto1*- 1Clinic for Neurology with Experimental Neurology, Charité University Medicine Berlin, Berlin, Germany
- 2MEOCLINIC GmbH, Berlin, Germany
- 3Dr. Spitz & Kollegen, practice for gastroenterology, Berlin, Germany
- 4Department of Neurology, University Hospital Jena, Jena, Germany
- 5Pathologie München-Nord, practice for pathology, München, Germany
- 6Division of Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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Abstract Background: Anti-CD20 therapies are widely used in patients with multiple sclerosis (pwMS). Recognition of rare adverse reactions to these therapies is therefore important. Objectives: To report dermatological and gastrointestinal adverse reactions in a single-center cohort of ocrelizumab treated pwMS. Methods: Retrospective analysis conducted at a multiple sclerosis outpatient clinic of Charité – Universitätsmedizin Berlin, Berlin, Germany, between March 2020 and February 2025. Results: Among 447 ocrelizumab treated pwMS, 8 (1.8%) developed dermatological adverse reactions after a median (range) of 20.5 (6-72) months following start of therapy, including lichen planus (n=2), rosacea (n=1), psoriatic arthritis (n=1), guttate psoriasis (n=1), psoriasis vulgaris (n=1), nail psoriasis (n=1) and palmoplantar psoriasis (n=1). Another 5 (1.1%) patients developed gastrointestinal adverse reactions 24 (0.25-77) months after starting therapy, including Crohn’s disease (n=1), toxic colitis (n=1), lymphocytic colitis (n=1), perforated appendicitis (n=1) and acute cholecystitis (n=1). Due to these adverse reactions, ocrelizumab was stopped in 7/13 patients. At last follow-up, adverse reactions had completely improved in 4/13, incompletely improved in 6/13, and persisted in 3/13 patients. Conclusions: Clinicians should be aware of dermatological and gastrointestinal adverse reactions associated with ocrelizumab, which can develop from a few weeks up to six years after start of therapy.
Keywords: anti-CD20 therapy, Colitis, Dermatological Adverse Reactions, Gastrointestinal adverse reactions, Lichen Planus, Multiple Sclerosis, Ocrelizumab, Psoriais
Received: 24 Nov 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Höpner, Marschall, Schindler, Frauendorf, Böhmig, Rakers, Karimi, Faber, Ruprecht and Otto. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Carolin Otto
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