Clinical Course of Relapsing Remitting Multiple Sclerosis Post-Natalizumab

Area of Science:

• Neurology
• Immunology
• Demyelinating Diseases

Background:

• Natalizumab is an effective disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS).
• Its use is often limited by the risk of progressive multifocal leukoencephalopathy (PML), particularly in JC virus antibody-positive individuals.
• Switching DMTs is a common strategy for managing RRMS when natalizumab is contraindicated or discontinued.

Purpose of the Study:

• To describe the clinical course of RRMS patients who switched from natalizumab to another DMT.
• To evaluate the efficacy of fingolimod as a subsequent therapy after natalizumab treatment in RRMS patients.

Main Methods:

• Retrospective identification of RRMS patients treated with natalizumab for at least 3 months.
• Inclusion criteria included JC virus antibody positivity and switching to a different DMT.
• Clinical outcomes, including relapse and disease progression, were assessed after switching to fingolimod.

Main Results:

• Eighty-four RRMS patients switched DMTs, with 57 (68%) initiating fingolimod.
• On fingolimod, 36-month survival without a relapse was 74% (95% CI 55.8-85.6%).
• Thirty-six-month survival without disease progression was 78% (95% CI 62.6-87.6%) on fingolimod.

Conclusions:

• Fingolimod demonstrates efficacy as a subsequent DMT in RRMS patients previously treated with natalizumab.
• This study supports fingolimod as a viable and effective treatment option for RRMS patients discontinuing natalizumab due to safety concerns.
• The findings highlight the importance of effective DMT sequencing in managing RRMS.