Journal of Neurology

, Volume 261, Issue 6, pp 1170–1177

Recurrence or rebound of clinical relapses after discontinuation of natalizumab therapy in highly active MS patients

  • Per Soelberg Sorensen
  • Nils Koch-Henriksen
  • Thor Petersen
  • Mads Ravnborg
  • Annette Oturai
  • Finn Sellebjerg
Original Communication


A number of studies have reported flare-up of multiple sclerosis (MS) disease activity after cessation of natalizumab, increasing to a level beyond the pre-natalizumab treatment level. Our aim was to describe the development in clinical disease activity following cessation of natalizumab therapy in a large unselected cohort of highly active patients. We studied 375 highly active patients who had suffered at least two significant relapses within 1 year or three relapses within 2 years, or had been treated with mitoxantrone for highly active disease. All patients had discontinued therapy with natalizumab after at least 24 weeks on therapy, and had been followed 3–12 months (mean 8.9 months) after cessation of natalizumab therapy. The annualised relapse rate before start of natalizumab therapy was 0.94 (95 % confidence interval [CI] 0.88–1.00), 0.47 (95 % CI 0.43–0.52) during natalizumab therapy, 0.63 (95 % CI 0.51–0.76) 1–6 months after natalizumab and 0.55 (95 % CI 0.42–0.70) 7–12 months after natalizumab. However, 83 (22 %) of the patients could be classified as showing rebound of relapses, defined as a higher individual relapse rate after cessation of natalizumab than before natalizumab. These patients had a higher annualised relapse rate during natalizumab therapy. For the whole patient group, the relapse rate after discontinuation did not exceed the pre-natalizumab relapse rate at any time, but 22 % of the patients showed rebound of relapses after discontinuation of natalizumab.


Natalizumab treatment discontinuation Relapse rebound Multiple sclerosis 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Per Soelberg Sorensen
    • 1
  • Nils Koch-Henriksen
    • 2
    • 3
    • 6
  • Thor Petersen
    • 4
  • Mads Ravnborg
    • 5
  • Annette Oturai
    • 1
  • Finn Sellebjerg
    • 1
  1. 1.Danish Multiple Sclerosis Center, Department of NeurologyRigshospitalet and University of CopenhagenCopenhagenDenmark
  2. 2.Department of Clinical Epidemiology, Clinical InstituteUniversity of AarhusÅrhusDenmark
  3. 3.The Danish Multiple Sclerosis Registry, Neuroscience CentreRigshospitalet, University of CopenhagenCopenhagenDenmark
  4. 4.Department of NeurologyAarhus University HospitalÅrhusDenmark
  5. 5.Department of NeurologyUniversity Hospital of OdenseOdenseDenmark
  6. 6.The Multiple Sclerosis RegistryRigshospitaletCopenhagenDenmark

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