title: Clinical and radiological disease reactivation after cessation of long-term therapy with natalizumab.
abstract: ABSTRACT  Naitalizumab is a potent monoclonal antibody approved for the treatment of relapsing-remitting multiple sclerosis (MS); however, little is known about the course of disease after cessation of therapy. The few existing reports describe different courses of disease after treatment discontinuation. Here we report on four MS patients who experienced clear clinical and radiological reactivation of the disease several months after cessation of therapy with natalizumab (15-29 months). In all cases, there was almost no clinical or radiological disease activity during natalizumab therapy. Three patients experienced a severe clinical relapse between 3 and 9 months after therapy cessation. The fourth patient developed cerebral magnetic resonance imaging (MRI) activity showing multiple new gadolinium-enhanced lesions. Due to these observations, it is recommended to weigh up the risk of disease reactivation against the risk of progressive multifocal leukoencephalopathy.
authors.affiliation: Department of Neurology, Albert Ludwigs University Freiburg, Germany. annette.baumgartner@uniklinik-freiburg.de
authors.forename: Annette
authors.initials: A
authors.lastname: Baumgartner
authors.forename: Oliver
authors.initials: O
authors.lastname: Stich
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rauer
mesh_terms: D000293:Adolescent; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D000069442:Natalizumab; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D055502:Secondary Prevention; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000473:pathology; D013995:Time; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab