title: Inflammatory Activity on Natalizumab Predicts Short-Term but Not Long-Term Disability in Multiple Sclerosis.
abstract: BACKGROUND
  In people with multiple sclerosis treated with interferon-beta or glatiramer acetate, new MRI lesions and relapses during the first year of treatment predict a poor prognosis.
  
  
  OBJECTIVE
  To study this association in those receiving natalizumab.
  
  
  METHODS
  Data were collected on relapses, new MRI activity, and Modified Rio Score after initiation of natalizumab in an observational cohort of 161 patients with high baseline disability. These were correlated with Expanded Disability Status Scale (EDSS) progression at years 1, 2, 3, and 3-7 after treatment initiation, versus pre-treatment baseline.
  
  
  RESULTS
  46/161 patients had a relapse in the first year and 44/161 had EDSS progression by year 2. Relapses and Modified Rio Score in the first year of treatment predicted EDSS progression at year 1 and 2 after treatment initiation. However, this effect disappeared with longer follow-up. Paradoxically, there was a trend towards inflammatory activity on treatment (first year Modified Rio Score, relapses, and MRI activity) predicting a lower risk of EDSS progression by years 3-7, although this did not reach statistical significance. Those with and without EDSS progression did not differ in baseline age, EDSS, or pre-treatment relapse rate. Relapses in year 0-1 predicted further relapses in years 1-3.
  
  
  CONCLUSIONS
  Breakthrough inflammatory activity after natalizumab treatment is predictive of short-term outcome measures of relapses or EDSS progression, but does not predict longer term EDSS progression, in this cohort with high baseline disability.
authors.affiliation: Department of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Joel
authors.initials: J
authors.lastname: Raffel
authors.affiliation: Department of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Arie R
authors.initials: AR
authors.lastname: Gafson
authors.affiliation: Department of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Samer
authors.initials: S
authors.lastname: Dahdaleh
authors.affiliation: Department of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Omar
authors.initials: O
authors.lastname: Malik
authors.affiliation: Department of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Brynmor
authors.initials: B
authors.lastname: Jones
authors.affiliation: Department of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Nicholas
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D000069442:Natalizumab / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000069442:Natalizumab