Treatment options to reduce disease activity after natalizumab: paradoxical effects of corticosteroids.
OBJECTIVE
Natalizumab (NTZ) discontinuation leads to multiple sclerosis (MS) recurrence, but represents the only known strategy to limit the risk of progressive multifocal leukoencephalopathy (PML) in JCV seropositive patients. Here, we compared the clinical and imaging features of three groups of patients who discontinued NTZ treatment.


METHODS
We treated 25 patients with subcutaneous INFβ-1b (INF group), 40 patients with glatiramer acetate (GA group), and 40 patients with GA plus pulse steroid (GA+CS group).


RESULTS
Six of 25 patients (24%) of the INF group were relapse-free 6 months after NTZ suspension. In GA group, a significant higher proportion of patients (26 of 40 patients, 65%) were relapse-free (P<0.05). Far from improving the clinical effects of GA in post-NTZ setting, combination of GA+CS was associated with lower relapse-free rate than GA alone (40% vs. 65%, P=0.04). Also on MRI parameters, combination of GA+CS was associated with worse outcome than GA alone, as 22 of 26 subjects (84.6%) had MRI evidence of disease activity 6 months after NTZ discontinuation.


CONCLUSIONS
Corticosteroids should not be used in combination with GA to prevent post-NTZ disease recurrence.
Clinica Neurologica, Dipartimento di Medicina dei Sistemi, Università Tor Vergata, & Centro Europeo per la Ricerca sul Cervello (CERC)/Fondazione Santa Lucia, Rome, Italy.
Silvia
S
Rossi
Caterina
C
Motta
Valeria
V
Studer
Laura
L
Boffa
Valentina
V
De Chiara
Maura
M
Castelli
Francesca
F
Barbieri
Fabio
F
Buttari
Fabrizia
F
Monteleone
Giorgio
G
Germani
Giulia
G
Macchiarulo
Sagit
S
Weiss
Diego
D
Centonze
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D004185:Disability Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D000068717:Glatiramer Acetate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000069442:Natalizumab; D010455:Peptides / Q000627:therapeutic use; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D000069442:Natalizumab; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta
Glatiramer acetate; Immunomodulation; JC virus; PML; Relapse