Natalizumab use in pediatric multiple sclerosis.
BACKGROUND
Natalizumab, a humanized monoclonal antibody raised against alpha4 integrins, is approved for treatment of active relapsing-remitting multiple sclerosis (RRMS) in adult patients.


OBJECTIVE
To determine the safety, effectiveness, and tolerability of natalizumab use in pediatric patients with MS.


METHODS
Case report.


METHODS
Center for MS in childhood and adolescents, Göttingen, Germany.


METHODS
Three pediatric patients with RRMS having a poor response to other immunomodulatory therapies or having intolerable adverse effects.


METHODS
Natalizumab given every 4 weeks at a dosage of 3 to 5 mg/kg of body weight.


METHODS
Cranial magnetic resonance (MR) imaging before treatment and every 6 months thereafter.


RESULTS
During 24, 16, and 15 months of treatment, no further relapses occurred in the 3 pediatric patients; all reported significant improvement in their quality of life. Follow-up MR imaging showed no new T2-weighted lesions or gadolinium-enhancing lesions. No adverse events were seen when dosage was adjusted to body weight.


CONCLUSIONS
Natalizumab treatment was effective and well tolerated in our pediatric patients with RRMS who did not respond to initial immunomodulatory treatments. Therefore, it is a promising second-line therapy for pediatric patients with RRMS.
Huppke
Peter
P
Department of Pediatrics and Pediatric Neurology, Faculty of Medicine, Georg August University, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany.
Stark
Wiebke
W
Zürcher
Claudia
C
Huppke
Brenda
B
Brück
Wolfgang
W
Gärtner
Jutta
J
D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000473:pathology; D000069442:Natalizumab; D010372:Pediatrics
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab