Switching patients at high risk of PML from natalizumab to another disease-modifying therapy.
There are several options for switching people with multiple sclerosis (MS) who are at high risk of developing progressive multifocal leukoencephalopathy (PML) from natalizumab to alemtuzumab. However, some of these have risks that need to be managed, for example, the risks of carrying over asymptomatic PML from natalizumab on to the new therapy, and the risk of rebound disease activity associated with a prolonged washout after starting natalizumab. We propose a pragmatic bridging strategy, using another disease-modifying therapy (DMT), to reduce the risk of switching from natalizumab to alemtuzumab. We also discuss the caveats and subtleties associated with sequencing DMTs in MS and the complex decision making involved.
Department of Neurosciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Gavin
G
Giovannoni
Department of Neurosciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Monica
M
Marta
Department of Neurosciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Angharad
A
Davis
Department of Neurosciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Benjamin
B
Turner
Department of Neurosciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Sharmilee
S
Gnanapavan
Department of Neurosciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Klaus
K
Schmierer
D000074323:Alemtuzumab; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000209:etiology*; D009103:Multiple Sclerosis / Q000188:drug therapy*; D000069442:Natalizumab / Q000627:therapeutic use*
D007155:Immunologic Factors; D000069442:Natalizumab; D000074323:Alemtuzumab
Alemtuzumab; MULTIPLE SCLEROSIS; Natalizumab; PML; progressive multifocal leukoencephalopathy