title: Pulsed corticosteroid treatment in MS patients stabilizes disease activity following natalizumab withdrawal prior to switching to fingolimod.
abstract: OBJECTIVE
  Interruption of natalizumab (NTM) treatment in multiple sclerosis (MS) patients may be followed by disease reactivation. On the other hand, patients with positive John Cunningham virus (JCV) antibodies treated with NTM over 24 months demonstrate a higher risk for developing progressive multifocal encephalopathy (PML). No established therapeutic approach is available for treating these patients to prevent disease reactivation.
  
  
  METHODS
  Of the MS patients treated with NTM at the authors' institution, 30 were found positive for JCV abs. NTM was interrupted followed by a washout period of 6 months. During this period, 20/30 patients received monthly intravenous (i.v.) methylprednisolone (MPD) 1000 mg infusion and regular clinical assessment. On months 3 and 6, brain MRI was performed and 1000 mg MPD was administered for 5 days.
  
  
  RESULTS
  All patients were clinically and radiologically stable at the time of NTM break. No clinical relapse was observed during the six-month washout period for the MS patients under monthly MPD treatment, while one patient had a relapse and active lesions in the MRI on month 6. Of the other patients not receiving i.v. MPD regularly after NTM withdrawal, one showed several active lesions in brain MRI and the other had a severe relapse.
  
  
  CONCLUSIONS
  Despite the limited size of this patients' cohort, the results of this study support that monthly MPD treatment for 6 months may result in a clinically stable disease status, thus ensuring safe transition to another second-line therapy such as fingolimod, following NTM withdrawal.
authors.affiliation: a 1 Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital , University of Athens , Athens , Greece.
authors.forename: M E
authors.initials: ME
authors.lastname: Evangelopoulos
authors.affiliation: b 2 Department of Radiology, Aretaieion Hospital , University of Athens , Athens , Greece.
authors.forename: V
authors.initials: V
authors.lastname: Koutoulidis
authors.affiliation: a 1 Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital , University of Athens , Athens , Greece.
authors.forename: E
authors.initials: E
authors.lastname: Andreadou
authors.affiliation: c 3 3rd Department of Orthopaedic Surgery, KAT Hospital , University of Athens , Athens , Greece.
authors.forename: D S
authors.initials: DS
authors.lastname: Evangelopoulos
authors.affiliation: a 1 Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital , University of Athens , Athens , Greece.
authors.forename: C
authors.initials: C
authors.lastname: Kilidireas
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D007577:JC Virus / Q000276:immunology; D007968:Leukoencephalopathy, Progressive Multifocal / Q000517:prevention & control*; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000821:virology; D000069442:Natalizumab / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D007155:Immunologic Factors; D000069442:Natalizumab; D000068876:Fingolimod Hydrochloride; D008775:Methylprednisolone
keywords: fingolimod; multiple sclerosis; natalizumab; pulsed corticosteroid treatment