The contraindications for Ocrelizumab mainly include patients with specific infection status, immune deficiency, and special physiological status. The risk benefit ratio must be strictly evaluated before deciding whether to use the drug.

1. Absolute taboo group

(1) Active infection patients

Active hepatitis B virus infection (those without control of HBsAg positive) is prohibited, because it may lead to reactivation of the virus and liver failure. Active tuberculosis patients need to complete anti tuberculosis treatment first, or they may increase the risk of infection spread.

(2) Severely immunocompromised individuals

HIV infected individuals with CD4 count<200/μ L are contraindicated as it may further impair cellular immune function. Patients with congenital immunodeficiency syndrome may develop fatal opportunistic infections after medication.

(3) Allergic individuals

Individuals allergic to Orelizumab or mouse derived protein components are contraindicated, and those who have experienced grade III or above infusion reactions with previous use of rituximab should be carefully evaluated.

2. Relatively taboo groups

(1) Cardiovascular disease patients

Uncontrolled heart failure (NYHA class III-IV) should be used with caution, as infusion reactions may exacerbate cardiac burden. Severe arrhythmia patients require slow infusion under electrocardiographic monitoring.

(2) Patients with neurological disorders

Progressive multiple sclerosis with severe disability (EDSS ≥ 7.0) requires a balance of benefits and may accelerate neurological degeneration. Individuals with a history of progressive multifocal white matter are contraindicated.

(3) Malignant tumor patients

Active malignant tumors (excluding basal cell carcinoma) require medication suspension, as immunosuppression may promote tumor progression. Patients with hematological tumors are prohibited from using it.

3. Taboos for special physiological states

(1) Pregnant women

Prohibited during pregnancy, animal studies have shown embryo fetal toxicity. Before medication, it is necessary to confirm a negative pregnancy test, and contraception is required during the treatment period and 6 months after the last dose.

(2) Lactating women

Medications may be secreted into breast milk, and breastfeeding should be suspended during lactation. If medication is required, it is recommended to resume breastfeeding at least 2 months after the last administration.

(3) Children and the elderly

The safety of children under 18 years old has not been established, and the risk of infection increases in elderly people over 65 years old, requiring strengthened monitoring. Patients with severe liver and kidney dysfunction (Child Pugh C grade or eGFR<30) need to adjust their dosage.