Natalizumab treatment for multiple sclerosis: recommendations for patient selection and monitoring.
Natalizumab is a new treatment option for patients with active relapsing-remitting multiple sclerosis. In phase III studies, natalizumab was highly effective and well tolerated; however, three cases of progressive multifocal leucoencephalopathy (PML) were identified (estimated incidence of one per 1000; 95% CI 0.2-2.8; mean treatment period 17.9 months). In this Review we summarise the current information on PML, the three confirmed cases of PML, and the results of an extensive safety assessment of all patients treated with natalizumab. On the basis of these reviews, we make recommendations for appropriate selection of candidates for natalizumab and pretreatment assessments. In addition, a three-step diagnostic and management algorithm was developed to monitor natalizumab-treated patients with multiple sclerosis for PML and other opportunistic infections. The algorithm includes strategies for clinical, MRI, and laboratory assessments. Maintaining clinical vigilance allows for early suspension of natalizumab in potential cases of PML, thereby increasing the opportunity for immune reconstitution, which may improve prognosis if PML is confirmed.
Kappos
Ludwig
L
University Hospital, Basel, Switzerland. lkappos@uhbs.ch
Bates
David
D
Hartung
Hans-Peter
HP
Havrdova
Eva
E
Miller
David
D
Polman
Chris H
CH
Ravnborg
Mads
M
Hauser
Stephen L
SL
Rudick
Richard A
RA
Weiner
Howard L
HL
O'Connor
Paul W
PW
King
John
J
Radue
Ernst Wilhelm
EW
Yousry
Tarek
T
Major
Eugene O
EO
Clifford
David B
DB
D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D000069442:Natalizumab; D018579:Patient Selection; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab