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Disease activity outcomes with different washout periods after switching from natalizumab to an alternative disease-modifying therapy

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Abstract

Background

Washout periods (WPs) are increasingly shortened due to concerns of disease rebound when patients on natalizumab are switched to alternative disease-modifying therapies (DMTs).

Objective

To characterize disease activity outcomes with different WPs when switching from natalizumab.

Methods

We conducted a retrospective review of patients switching from natalizumab in our MS clinics. Disease activity (relapse, new T2 lesions and/or gadolinium enhancing lesions) between different WPs (days): 0–30, 31–60, and 61–180 were compared, during the first year after switching from natalizumab. To determine predictors of disease activity when switching to any DMT, multivariate logistic regression analysis was used. Post hoc analyses were performed to evaluate the impact of individual DMTs on disease activity.

Results

335 patients discontinued natalizumab with WP: 0–30 (n = 104), 31–60 (n = 113), and 61–180 (n = 136). Disease activity occurred in 44.2% of patients in the 0–30 WP group, 18.6% in the 31–60 WP group, and 27.2% in the 61–180 WP group. There was a significant decrease in odds of disease activity with longer WP when compared to the 0–30 group: 31–60 (OR 0.241, 95% CI 0.108–0.514, p value < 0.001), and 61–180 (OR 0.439, 95% CI 0.218–0.871, p value < 0.05).

Conclusions

Unexpectedly, in our study, patients who had the shortest WP 0–30 days had the most disease activity. Shortening WPs may not be enough to suppress disease activity post-natalizumab switch.

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Funding

LHH received research support from the Sheila and Eric Samson Foundation.

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Authors and Affiliations

  1. Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W. Bonneville Ave, Las Vegas, NV, 89138, USA

    Le H. Hua, Haleigh Harris & Carrie M. Hersh

  2. Cleveland Clinic Mellen Center for Multiple Sclerosis, Cleveland, OH, USA

    Devon Conway

Authors
  1. Le H. Hua
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  2. Haleigh Harris
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  3. Devon Conway
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  4. Carrie M. Hersh
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Corresponding author

Correspondence to Le H. Hua.

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Conflicts of interests

LHH received personal compensation for speaking, consulting, or advisory board activities from Biogen, Genzyme, Genentech, Novartis, Celgene and EMD Serono. HH has nothing to disclose. DC has received research support paid to his institution from Novartis Pharmaceuticals and the National Multiple Sclerosis Society. He has received personal compensation for consulting from Novartis Pharmaceuticals and Tanabe Laboratories. CMH receives personal compensation for speaking and consulting from Genzyme, Genentech, EMD-Serono, Novartis, and Biogen. She has received research support paid to her institution by Biogen, Genentech, and PCORI.

Ethical standard statement

This study was approved by the local Institutional Review Board of the Cleveland Clinic Foundation.

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Hua, L.H., Harris, H., Conway, D. et al. Disease activity outcomes with different washout periods after switching from natalizumab to an alternative disease-modifying therapy. J Neurol 267, 2214–2220 (2020). https://doi.org/10.1007/s00415-020-09816-1

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  • DOI: https://doi.org/10.1007/s00415-020-09816-1

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