title: De-escalation from natalizumab in multiple sclerosis: recurrence of disease activity despite switching to glatiramer acetate.
abstract: Natalizumab (NAT) is an effective therapy for relapsing-remitting multiple sclerosis (MS), but is associated with an increased risk of progressive multifocal leucoencephalopathy after 2 years therapy. Thus, NAT treated patients often decide to stop NAT therapy after 2 years. Reports on recurrence of disease activity after NAT discontinuation are controversial. We studied disease activity in 13 MS patients who stopped NAT therapy and either remained without disease modifying therapy (no DMT, n = 6), or switched to glatiramer acetate (GLAT, n = 7). Annual relapse rate (ARR), expanded disability status scale (EDSS), and number of patients with contrast-enhancing-lesions (Gd+) on MRI before, during and within 1 year after NAT were determined. We observed recurrence of disease activity in both groups (5/7 GLAT treated patients and 6/6 patients without DMT) within 12 months after cessation of NAT (mean time to first relapse was 5.5 months for all patients). One of the GLAT treated patients and three patients without DMT had severe relapses with sustained EDSS worsening. No differences in ARR, EDSS and MRI parameters were seen between both groups. Patients with relapses after NAT therapy, however, tended to show higher disease activity (EDSS, ARR) before initiation of NAT therapy compared to patients without relapses. Duration of NAT treatment was not associated with higher disease activity after NAT discontinuation. In this observation the majority of patients showed reappearance of disease activity after discontinuation of NAT regardless of whether they switched to GLAT or remained without DMT. Further treatment strategies are warranted for patients who discontinue NAT therapy.
authors: Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany.
authors: Joachim
authors: J
authors: Havla
authors: Lisa Ann
authors: LA
authors: Gerdes
authors: Ingrid
authors: I
authors: Meinl
authors: Markus
authors: M
authors: Krumbholz
authors: Hans
authors: H
authors: Faber
authors: Frank
authors: F
authors: Weber
authors: Hannah Luise
authors: HL
authors: Pellkofer
authors: Reinhard
authors: R
authors: Hohlfeld
authors: Tania
authors: T
authors: Kümpfel
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D000068717:Glatiramer Acetate; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016023:Integrins / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000473:pathology*; D000069442:Natalizumab; D010455:Peptides / Q000008:administration & dosage*; D055502:Secondary Prevention; D013375:Substance Withdrawal Syndrome / Q000473:pathology* / Q000503:physiopathology
chemical_list: D000276:Adjuvants, Immunologic; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D016023:Integrins; D000069442:Natalizumab; D010455:Peptides; C071777:integrin alpha4beta7; D000068717:Glatiramer Acetate