title: Treating multiple sclerosis in the natalizumab era: risks, benefits, clinical decision making, and a comparison between North American and European Union practices.
abstract: Multiple sclerosis (MS) is the most common cause of nontraumatic severe neurological disability in young adults. If left untreated, most individuals with MS will accumulate significant physical and/or cognitive disability as the consequence of demyelination and axonal injury. Treatment has focused on disease-modifying therapies (DMTs) and questions remain about timing and indications for their use. Natalizumab is a humanized monoclonal antibody directed against alpha4-integrin that prevents migration of leukocytes into the brain parenchyma. The clinical and radiological efficacy of natalizumab has been shown in several randomized trials; however, adverse events associated with natalizumab have limited its use as a first-line agent. In this review we compare current recommendations for the use of first-line DMTs, adverse events associated with MS therapies, and differences between the practices in North American and the European Union.
authors.affiliation: Neuroimmunology Unit, Neuroscience Centre, Institute of Cell and Molecular Science, Queen Mary's School of Medicine and Dentistry, Whitechapel, London.
authors.forename: Gavin
authors.initials: G
authors.lastname: Giovannoni
authors.forename: Philip
authors.initials: P
authors.lastname: Kinkel
authors.forename: Timoth
authors.initials: T
authors.lastname: Vartanian
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D003657:Decision Making; D005060:Europe; D006801:Humans; D009103:Multiple Sclerosis / Q000188:drug therapy*; D000069442:Natalizumab; D009656:North America; D017410:Practice Guidelines as Topic; D018570:Risk Assessment
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab