title: Alternatives for reducing relapse rate when switching from natalizumab to fingolimod in multiple sclerosis.
abstract: Natalizumab is a therapeutic option for treating multiple sclerosis (MS) and is particularly efficacious for patients with highly active disease. A long washout period has been recommended between withdrawal of natalizumab and start of fingolimod (another option for treating MS). This long washout period has been associated with a significant increase in MS activity. In the present study, a group of 96 patients who were switched from natalizumab to fingolimod had short washout periods between drugs, or monthly corticosteroid pulse therapy if longer washout periods were recommended. This therapeutic approach led to the lowest reported relapse rate so far, among patients with MS switching from natalizumab to fingolimod (8.3%). No complications from short withdrawal were observed in this group of patients.
authors.affiliation: a Department of Neurology , Universidade Metropolitana de Santos , Santos , Brazil.
authors.forename: Yara Dadalti
authors.initials: YD
authors.lastname: Fragoso
authors.affiliation: b Department of Neurology , Hospital Sirio Libanes , Sao Paulo , Brazil.
authors.forename: Tarso
authors.initials: T
authors.lastname: Adoni
authors.affiliation: c Department of Neurology , Universidade Federal do Estado do Rio de Janeiro , Rio de Janeiro , Brazil.
authors.forename: Soniza Vieira
authors.initials: SV
authors.lastname: Alves-Leon
authors.affiliation: d Department of Neurology , Hospital das Clinicas da Universidade de Sao Paulo , Sao Paulo , Brazil.
authors.forename: Samira Luisa
authors.initials: SL
authors.lastname: Apostolos-Pereira
authors.affiliation: e Department of Neurology , Hospital de Base do Distrito Federal , Brasilia , Brazil.
authors.forename: Yuna Ribeiro de
authors.initials: YR
authors.lastname: Araujo
authors.affiliation: f Department of Neurology , Pontificia Universidade Catolica do Rio Grande do Sul , Porto Alegre , Brazil.
authors.forename: Jefferson
authors.initials: J
authors.lastname: Becker
authors.affiliation: a Department of Neurology , Universidade Metropolitana de Santos , Santos , Brazil.
authors.forename: Joseph Bruno Bidin
authors.initials: JBB
authors.lastname: Brooks
authors.affiliation: g Department of Neurology , CLINEN , Brasilia , Brazil.
authors.forename: Eber Castro
authors.initials: EC
authors.lastname: Correa
authors.affiliation: h Department of Neurology , Universidade Estadual de Campinas , Campinas , Brazil.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Damasceno
authors.affiliation: i Department of Neurology , Universidade Federal de Juiz de Fora , Juiz de Fora , Brazil.
authors.forename: Carlos Augusto de Albuquerque
authors.initials: CAA
authors.lastname: Damasceno
authors.affiliation: j Department of Neurology , Hospital da Restauracao , Recife , Brazil.
authors.forename: Maria Lucia B
authors.initials: MLB
authors.lastname: Ferreira
authors.affiliation: k Department of Neurology , Pontificia Universidade Catolica Sorocaba , Sorocaba , Brazil.
authors.forename: Paulo Diniz da
authors.initials: PDD
authors.lastname: Gama
authors.affiliation: k Department of Neurology , Pontificia Universidade Catolica Sorocaba , Sorocaba , Brazil.
authors.forename: Rodrigo Assad Diniz da
authors.initials: RADD
authors.lastname: Gama
authors.affiliation: l Department of Neurology , Hospital Beneficencia Portuguesa de Sao Paulo , São Paulo , Brazil.
authors.forename: Sidney
authors.initials: S
authors.lastname: Gomes
authors.affiliation: m Department of Neurology , Regional Hans Dieter Schimidt, Centro Hospitalar Unimed , Joinville , Brazil.
authors.forename: Marcus Vinicius Magno
authors.initials: MVM
authors.lastname: Goncalves
authors.affiliation: n Department of Neurology , CRIDAC , Cuiaba , Brazil.
authors.forename: Anderson Kuntz
authors.initials: AK
authors.lastname: Grzesiuk
authors.affiliation: o Department of Neurology , Hospital de Caridade , Florianopolis , Brazil.
authors.forename: Suzana Costa Nunes
authors.initials: SCN
authors.lastname: Machado
authors.affiliation: p Department of Neurology , Universidade Federal Fluminense , Niteroi , Brazil.
authors.forename: Andre Palma da Cunha
authors.initials: APDC
authors.lastname: Matta
authors.affiliation: q Department of Neurology , Irmandade da Santa Casa de Misericordia de Sao Paulo , Sao Paulo , Brazil.
authors.forename: Maria Fernanda
authors.initials: MF
authors.lastname: Mendes
authors.affiliation: r Department of Neurology , Universidade Federal de Goias , Goiania , Brazil.
authors.forename: Taysa Alexandrino Goncalves Jube
authors.initials: TAGJ
authors.lastname: Ribeiro
authors.affiliation: s Department of Neurology , Neurological Clinic Belo Horizonte , Belo Horizonte , Brazil.
authors.forename: Cristiane Franklin da
authors.initials: CFD
authors.lastname: Rocha
authors.affiliation: t Department of Neurology , Universidade de Jundiai , Jundiai , Brazil.
authors.forename: Heloisa Helena
authors.initials: HH
authors.lastname: Ruocco
authors.affiliation: u Department of Neurology , Neurological Institute Curitiba , Curitiba , Brazil.
authors.forename: Henry
authors.initials: H
authors.lastname: Sato
authors.affiliation: d Department of Neurology , Hospital das Clinicas da Universidade de Sao Paulo , Sao Paulo , Brazil.
authors.forename: Renata Faria
authors.initials: RF
authors.lastname: Simm
authors.affiliation: e Department of Neurology , Hospital de Base do Distrito Federal , Brasilia , Brazil.
authors.forename: Carlos Bernardo
authors.initials: CB
authors.lastname: Tauil
authors.affiliation: c Department of Neurology , Universidade Federal do Estado do Rio de Janeiro , Rio de Janeiro , Brazil.
authors.forename: Claudia Cristina Ferreira
authors.initials: CCF
authors.lastname: Vasconcelos
authors.affiliation: v Department of Neurology , Universidade Federal do Espirito Santo , Vitoria , Brazil.
authors.forename: Vera Lucia Ferreira
authors.initials: VLF
authors.lastname: Vieira
keywords: Natalizumab; fingolimod; multiple sclerosis; progressive multifocal leukoencephalopathy