Efficacy of natalizumab in second line therapy of relapsing-remitting multiple sclerosis: results from a multi-center study in German speaking countries.
BACKGROUND
Natalizumab has been recommended for the treatment of relapsing-remitting multiple sclerosis (RRMS) in patients with insufficient response to interferon-beta/glatiramer acetate (DMT) or aggressive MS. The pivotal trials were not conducted to investigate natalizumab monotherapy in this patient population.


METHODS
Retrospective, multicenter study in Germany and Switzerland. Five major MS centers reported all RRMS patients who initiated natalizumab >or=12 months prior to study conduction.


RESULTS
Ninety-seven RRMS patients were included [69% female, mean age 36.5 years, mean Expanded Disability Status Scale (EDSS) 3.4; 93.8% were pre-treated with DMT], mean treatment duration with natalizumab was 19.3 +/- 6.1 months. We found a reduction of the annualized relapse rate from 2.3 to 0.2, 80.4% were relapse free with natalizumab. EDSS improved in 12.4% and 89.7% were progression free (change of >or= 1 EDSS point). Eighty-six per cent of patients with highly active disease (>or= 2 relapses in the year and >or= 1 Gadolinium (Gd)+ lesion at study entry, n = 20) remained relapse free. The mean number of Gd enhancing lesions was reduced to 0.1 (0.8 at baseline). Discontinuation rate was 8.2% (4.1% for antibody-positivity).


CONCLUSIONS
Natalizumab is effective after insufficient response to other DMT and also in patients with high disease activity.
Putzki
N
N
Department of Neurology, University Clinic Essen, University of Duisburg-Essen, Germany. norman.putzki@uni-due.de
Yaldizli
O
O
Mäurer
M
M
Cursiefen
S
S
Kuckert
S
S
Klawe
C
C
Maschke
M
M
Tettenborn
B
B
Limmroth
V
V
D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D002490:Central Nervous System / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D003287:Contrast Media; D004185:Disability Evaluation; D004351:Drug Resistance / Q000276:immunology*; D005260:Female; D005682:Gadolinium; D005858:Germany; D000068717:Glatiramer Acetate; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016899:Interferon-beta / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D000069442:Natalizumab; D017063:Outcome Assessment, Health Care; D010455:Peptides / Q000627:therapeutic use; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D017211:Treatment Failure; D055815:Young Adult
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003287:Contrast Media; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069442:Natalizumab; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D005682:Gadolinium