title: Natalizumab drug holiday in multiple sclerosis: poorly tolerated.
abstract: It has been suggested that natalizumab-associated progressive multifocal leukoencephalopathy may be prevented by structured interruptions of treatment. Evidence supporting such a drug holiday is not yet available. Here we present initial observations in 10 multiple sclerosis patients who were stringently monitored up to 6 months after discontinuation of the infusions. Cumulatively, a combination of clinical relapse and new and/or enhanced lesions on magnetic resonance imaging had occurred in 7 of 10 patients. Although numbers are small, our data suggest that in patients who were switched to natalizumab because of disease activity despite first-line treatment, a natalizumab drug holiday without reinstatement of alternate disease-modifying therapy is poorly tolerated.
authors.affiliation: Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands. j.killestein@vumc.nl
authors.forename: Joep
authors.initials: J
authors.lastname: Killestein
authors.forename: Anke
authors.initials: A
authors.lastname: Vennegoor
authors.forename: Eva M
authors.initials: EM
authors.lastname: Strijbis
authors.forename: Alexandra
authors.initials: A
authors.lastname: Seewann
authors.forename: Bob W
authors.initials: BW
authors.lastname: van Oosten
authors.forename: Bernard M J
authors.initials: BM
authors.lastname: Uitdehaag
authors.forename: Chris H
authors.initials: CH
authors.lastname: Polman
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D039441:Integrin alpha4 / Q000276:immunology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*; D000069442:Natalizumab; D012008:Recurrence
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab; D039441:Integrin alpha4