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Disease reactivation after switching from natalizumab to daclizumab


Discontinuation of natalizumab can lead to severe rebound of disease activity in patients with relapsing–remitting multiple sclerosis (RRMS); nevertheless, the treatment regimen in this clinical situation remains controversial. We report the case of a 25-year-old male patient with RRMS who was clinically stable under 3 years of natalizumab before treatment was stopped due to progressive multifocal leucencephalopathy (PML) safety concerns. After initiation of daclizumab, the patient suffered from disease reactivation, which was ultimately controlled by intravenous methylprednisolone and alemtuzumab treatment. Therefore, in some patients, daclizumab might not be sufficient to control disease activity after discontinuing natalizumab treatment.

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The authors thank Cheryl Ernest for proofreading and editing the manuscript.

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Correspondence to Stefan Bittner.

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Conflicts of interest

FZ has received research grants from Teva, Merck Serono, Novartis and Bayer as well as consultation funds from Teva, Merck Serono, Novartis, Bayer Healthcare, Biogen Idec Germany, ONO, Genzyme, Sanofi-Aventis and Octapharma. Her travel compensation has been provided for by the aforementioned companies. S. B. has received consultation funds and travel compensation from Biogen Idec, Sanofi-Genzyme, Roche and Merck Serono. C.O. has received travel compensation from Genzyme. T.U. and S.G. declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the German Research Council (DFG, CRC-TR-128).

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All procedures performed in studies involving humans participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendment or comparable ethical standards.

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The patient was informed on the intention to publish the case report and gave their consent.

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Uphaus, T., Oberwittler, C., Groppa, S. et al. Disease reactivation after switching from natalizumab to daclizumab. J Neurol 264, 2491–2494 (2017).

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  • Multiple Sclerosis
  • Daclizumab
  • Natalizumab
  • Rebound
  • Disease reactivation
  • Relapse