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Switching from natalizumab to fingolimod: an observational study
A P Sempere1, P Martín-Medina, L Berenguer-Ruiz
1Neurology Department, Hospital General Universitario de Alicante, Alicante, Spain. aperezs@mac.com
Acta Neurologica Scandinavica
|January 23, 2013
Summary
Switching natalizumab (an MS therapy) to fingolimod for JC virus-positive patients risks disease reactivation. Fingolimod did not prevent relapses or MRI activity, indicating a need for better alternative treatments post-natalizumab discontinuation.
Area of Science:
- Neurology
- Immunology
- Pharmacology
Background:
- Discontinuation of natalizumab in multiple sclerosis (MS) patients can lead to disease activity rebound.
- The optimal alternative therapy following natalizumab cessation remains undetermined.
Purpose of the Study:
- To evaluate clinical and MRI outcomes and safety in JC virus-seropositive relapsing-remitting MS patients switching from natalizumab to fingolimod.
- To assess fingolimod's efficacy as an alternative therapy after natalizumab treatment.
Main Methods:
- JC virus antibody testing was performed on 18 natalizumab-treated relapsing-remitting MS patients.
- Eight JC virus-seropositive patients switched to fingolimod; seronegative patients continued natalizumab.
Main Results:
- 63% of patients switching to fingolimod experienced clinical relapses.
- 75% of patients on fingolimod showed MRI-detected disease activity.
- No relapses or MRI activity occurred in patients continuing natalizumab.
Conclusions:
- Natalizumab is effective for relapsing-remitting MS, but discontinuation poses challenges.
- Fingolimod did not effectively control disease reactivation after natalizumab cessation.
- Further research is required to identify effective alternative therapies for MS patients discontinuing natalizumab.
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