title: Natalizumab in multiple sclerosis: discontinuation, progressive multifocal leukoencephalopathy and possible use in children.
abstract: In the early 1990s, attention was drawn to the migration of immune cells into the central nervous system via the blood-brain barrier. The literature showed that lymphocytes binding to the endothelium were successfully inhibited by an antibody against α4β1 integrin. These biological findings resulted in the development of a humanized antibody to α4 integrin - natalizumab (NTZ) - to treat multiple sclerosis (MS). Here, we provide a systematic review and meta-analysis on the efficacy and safety of natalizumab, trying to answer the question whether its use may be recommended both in adult and in pediatric age groups as standard MS treatment. Our results highlight the improvement of clinical and radiological findings in treated patients (p < 0.005), confirming NTZ efficacy. Nevertheless, if NTZ is shown to be efficient, further studies should be performed to evaluate its safety and to target the MS profile that could benefit from this treatment.
authors.affiliation: a General Paediatrics Operative Unit , Policlinico-Vittorio-Emanuele University Hospital, University of Catania , Catania , Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Vitaliti
authors.affiliation: b Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Nassim
authors.initials: N
authors.lastname: Matin
authors.affiliation: b Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Omidreza
authors.initials: O
authors.lastname: Tabatabaie
authors.affiliation: c Department of Statistics , La Sapienza University of Rome , Rome , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Di Traglia
authors.affiliation: a General Paediatrics Operative Unit , Policlinico-Vittorio-Emanuele University Hospital, University of Catania , Catania , Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Pavone
authors.affiliation: d Paediatric Department, Paediatric Nephrology Operative Unit , Sapienza University of Rome , Rome , Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lubrano
authors.affiliation: a General Paediatrics Operative Unit , Policlinico-Vittorio-Emanuele University Hospital, University of Catania , Catania , Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Falsaperla
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002985:Clinical Protocols; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000188:drug therapy; D009103:Multiple Sclerosis / Q000188:drug therapy*; D000069442:Natalizumab / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab
keywords: efficacy; meta-analysis; multiple sclerosis; natalizumab; safety