This is a challenging situation to confront, however, as more non- rheumatological illnesses are being managed with biologics, we will be facing this issue with greater frequency. Regarding multiple sclerosis (MS), one should be aware that the major metabolite of leflunomide, teriflunomide, is a br...

I agree with Dr. Helfgott’s comments, particularly with respect to the idea of adding teriflunomide. I would also consider adding methotrexate. Ocrelizumab, like rituximab, targets CD20, and in the earliest clinical trials with rituximab, the drug was significantly more effective when used in ...