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Area of Science:

  • Neurology
  • Immunology
  • Radiology

Background:

  • Natalizumab (NTZ) is an effective treatment for relapsing-remitting multiple sclerosis (MS).
  • Cessation of NTZ treatment can lead to disease recurrence, termed 'rebound'.
  • The characteristics and timing of MS inflammatory activity post-NTZ cessation require further elucidation.

Purpose of the Study:

  • To characterize the recurrence of inflammatory activity in multiple sclerosis (MS) during the year after discontinuing natalizumab (NTZ).
  • To identify the clinical and MRI features associated with MS rebound following NTZ cessation.

Main Methods:

  • A monocentric cohort study included 32 patients with MS undergoing NTZ treatment.
  • Prospective data collection included serial clinical and MRI evaluations during and after NTZ therapy.
  • The primary outcome was the first relapse after NTZ interruption; gadolinium-enhancing lesions were compared pre-, during, and post-NTZ.

Main Results:

  • The cumulative probability of relapse within one year post-NTZ cessation was 52.9%.
  • Unusual MRI inflammation (gadolinium-enhancing lesions >5, exceeding pre-NTZ levels) was frequently observed.
  • MS rebound, defined by relapses and high MRI activity, occurred in 39% of patients, primarily between 3-9 months after NTZ cessation.

Conclusions:

  • MS rebound after NTZ cessation is characterized by the co-occurrence of clinical relapses and significant MRI-detected inflammatory activity.
  • Risk factors for rebound include a higher pre-NTZ annualized relapse rate and lower Expanded Disability Status Scale score.
  • Severe relapses were associated with rebound in 9% of patients.