title: Natalizumab in spinal multiple sclerosis in a daily clinical setting.
abstract: OBJECTIVE
  We aimed to investigate the influence of natalizumab (NTZ) treatment on multiple sclerosis course in patients with and without spinal involvement.
  
  
  METHODS
  Annualized relapse rate (ARR), disability progression and occurrence of new brain and spinal T2 lesions (N2TL) in 68 spinal (S-P) versus 68 non-spinal matched patients (NS-P) were retrospectively collected and compared between before (2 years) and after NTZ treatment using multivariate regression models.
  
  
  RESULTS
  Mean duration of NTZ treatment was 31.3 ± 16.3 months in S-P and 32.1 ± 15.1 months in N-SP (p = 0.56). The mean ARR after NTZ treatment was similarly reduced in both S-P (0.07 ± 0.19) and N-SP (0.07 ± 0.16) (p < 0.001 for both). Disability progression after NTZ start was similarly low in S-P and NS-P. However, when compared to before NTZ start, disability progression was significantly reduced in S-P (p = 0.017), but not in NS-P (p = 0.68). This was largely mediated by a higher disability progression before NTZ start in S-P than N-SP. The risk of developing N2TL during NTZ was not different between S-P and NS-P (p = 0.10).
  
  
  CONCLUSIONS
  NTZ similarly reduced the occurrence of relapses and NT2L in S-P and NS-P, whereas the effect on disability progression was particularly evident in the presence of spinal involvement. NTZ appears to be a treatment of high efficacy in both S-P and NS-P.
authors.affiliation: Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano , Via Tesserete 46, CH-6903 Lugano , Switzerland +41 91 811 6921 ; +41 91 811 6915 ; chiara.zecca@eoc.ch.
authors.forename: Chiara
authors.initials: C
authors.lastname: Zecca
authors.forename: Mirjam R
authors.initials: MR
authors.lastname: Heldner
authors.forename: Christian P
authors.initials: CP
authors.lastname: Kamm
authors.forename: Gianna C
authors.initials: GC
authors.lastname: Riccitelli
authors.forename: Giulio
authors.initials: G
authors.lastname: Disanto
authors.forename: Matteo
authors.initials: M
authors.lastname: Caporro
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cianfoni
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pravatà
authors.forename: Claudio
authors.initials: C
authors.lastname: Gobbi
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis* / Q000188:drug therapy*; D000069442:Natalizumab; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab
keywords: multiple sclerosis; natalizumab; relapses; spinal cord