Abstract
Natalizumab (NAT) is an effective therapy for relapsing–remitting multiple sclerosis (MS), but is associated with an increased risk of progressive multifocal leucoencephalopathy after 2 years therapy. Thus, NAT treated patients often decide to stop NAT therapy after 2 years. Reports on recurrence of disease activity after NAT discontinuation are controversial. We studied disease activity in 13 MS patients who stopped NAT therapy and either remained without disease modifying therapy (no DMT, n = 6), or switched to glatiramer acetate (GLAT, n = 7). Annual relapse rate (ARR), expanded disability status scale (EDSS), and number of patients with contrast-enhancing-lesions (Gd+) on MRI before, during and within 1 year after NAT were determined. We observed recurrence of disease activity in both groups (5/7 GLAT treated patients and 6/6 patients without DMT) within 12 months after cessation of NAT (mean time to first relapse was 5.5 months for all patients). One of the GLAT treated patients and three patients without DMT had severe relapses with sustained EDSS worsening. No differences in ARR, EDSS and MRI parameters were seen between both groups. Patients with relapses after NAT therapy, however, tended to show higher disease activity (EDSS, ARR) before initiation of NAT therapy compared to patients without relapses. Duration of NAT treatment was not associated with higher disease activity after NAT discontinuation. In this observation the majority of patients showed reappearance of disease activity after discontinuation of NAT regardless of whether they switched to GLAT or remained without DMT. Further treatment strategies are warranted for patients who discontinue NAT therapy.
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Acknowledgments
Sabine Pitter, Heike Staufer and H. Sahm-Traore provided excellent technical assistance. The authors thank Drs. M. Kerschensteiner and E. Meinl for helpful comments on the manuscript.
Conflict of interest
R.H. is supported by the Deutsche Forschungsgemeinschaft (SFB 571, A1) and has received personal compensations from Bayer Schering Pharmacy, Teva, Merck-Serono, Biogen-Idec, and Novartis. T.K. has received personal compensations from Bayer Schering Pharmacy, Teva, Merck-Serono, and Biogen-Idec, grant support from Bayer-Schering AG. F.W. has received personal compensations from Bayer-Schering AG, Biogen Idec, Orion Pharma, Pfizer-Pharma, Merck-Serono, grant support from Bayer-Schering AG, Merck-Serono and TEVA Pharma GmbH. H.P., L.G. and J.H. have received personal compensations from Merck-Serono, Teva, Bayer-Schering, Novartis, Merz Pharma and Biogen-Idec. H.F. has received personal compensations from Merck-Serono, Teva, Novartis and Biogen-Idec. I.M. has received personal compensations from Bayer-Schering. The other authors report no disclosures.
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Havla, J., Gerdes, L.A., Meinl, I. et al. De-escalation from natalizumab in multiple sclerosis: recurrence of disease activity despite switching to glatiramer acetate. J Neurol 258, 1665–1669 (2011). https://doi.org/10.1007/s00415-011-5996-y
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DOI: https://doi.org/10.1007/s00415-011-5996-y