title: Natalizumab treatment for multiple sclerosis: recommendations for patient selection and monitoring.
abstract: 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.
authors: University Hospital, Basel, Switzerland. lkappos@uhbs.ch
authors: Ludwig
authors: L
authors: Kappos
authors: David
authors: D
authors: Bates
authors: Hans-Peter
authors: HP
authors: Hartung
authors: Eva
authors: E
authors: Havrdova
authors: David
authors: D
authors: Miller
authors: Chris H
authors: CH
authors: Polman
authors: Mads
authors: M
authors: Ravnborg
authors: Stephen L
authors: SL
authors: Hauser
authors: Richard A
authors: RA
authors: Rudick
authors: Howard L
authors: HL
authors: Weiner
authors: Paul W
authors: PW
authors: O'Connor
authors: John
authors: J
authors: King
authors: Ernst Wilhelm
authors: EW
authors: Radue
authors: Tarek
authors: T
authors: Yousry
authors: Eugene O
authors: EO
authors: Major
authors: David B
authors: DB
authors: Clifford
mesh_terms: 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
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab