title: Relapse frequency in transitioning from natalizumab to dimethyl fumarate: assessment of risk factors.
abstract: Risk of relapse after natalizumab (NAT) cessation and switch to dimethyl fumarate (DMF) is unknown. The objective of this paper is to identify the risk and associated risk factors for relapse after switching from NAT to DMF in relapsing-remitting multiple sclerosis. Patients (n = 30) were treated with NAT for ≥12 months and then switched to DMF in a mean of 50 days. Patient age, annualized relapse rates (ARR), Expanded Disability Status Scale scores (EDSS), and lymphocyte counts were assessed. Overall, eight patients (27 %) had relapses after switching to DMF. Five patients (17 %) suffered severe relapses with multifocal clinical and radiological findings. New lesions by MRI (T2 hyperintense or enhancing) were observed in 35 % of patients. Relapses occurred at a mean of 3.5 months after NAT cessation. Patient age and elevated ARR prior to NAT use were significantly associated with risk of relapse after switch to DMF. Once on DMF for 4 months prior to relapse, lymphocyte count decreased more significantly in patients without relapses than those with relapses. Switching from NAT to DMF correlated with increased relapses. Young patient age, high ARR and stability of lymphocyte counts were risk factors for relapse after transition from NAT to DMF.
authors.affiliation: Department of Neurology, BIDMC MS Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Zurawski
authors.affiliation: Department of Neurology, BIDMC MS Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Flinn
authors.affiliation: Department of Neurology, BIDMC MS Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Sklover
authors.affiliation: Department of Neurology, BIDMC MS Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Ks212, Boston, MA, 02115, USA. jsloane@bidmc.harvard.edu.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Sloane
mesh_terms: D000328:Adult; D000069462:Dimethyl Fumarate / Q000009:adverse effects*; D004185:Disability Evaluation; D057915:Drug Substitution / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000453:epidemiology; D000069442:Natalizumab / Q000009:adverse effects*; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D007155:Immunologic Factors; D000069442:Natalizumab; D000069462:Dimethyl Fumarate
keywords: Dimethyl fumarate; Lymphocytes; Multiple sclerosis; Natalizumab; Relapse; Risk