Catastrophic outcome of patients with a rebound after Natalizumab treatment discontinuation.
Brain Behav
; 7(4): e00671, 2017 04.
Article
in En
| MEDLINE
| ID: mdl-28413713
ABSTRACT
INTRODUCTION:
Natalizumab (NTZ) is an effective drug for the treatment of relapsing-remitting multiple sclerosis. In some patients discontinuation is mandatory due to the risk of progressive multifocal leukoencephalopathy. However, severe clinical and radiological worsening has been described after drug cessation. Our aim was to describe the clinical and radiological features of the rebound phenomenon. MATERIAL ANDMETHODS:
Patients switched from NTZ to Fingolimod (FTY) who had presented a rebound after discontinuation were selected. Clinical and magnetic resonance imaging (MRI) data were collected.RESULTS:
Four JC virus positive patients were included. The mean disease duration was 9.5 years (SD 4.12) with a mean time of 3.1 years on NTZ. All patients started FTY within 3-4 months. Neurological deterioration started in a mean time of 3.5 months (SD 2.08) with multifocal involvement 75% motor disturbances, 50% cognitive impairment, 25% seizures. The average worsening in Expanded Disability Status Scale [EDSS] was of 3.25 points (SD 2.33). The MRI showed a very large increase in T2 and gadolinium-enhanced lesions (mean 23.67, SD 18.58). All patients received 5 days of IV methylprednisolone, one patient required plasma exchange. All the patients presented neurological deterioration with an EDSS worsening of 1.13 points (SD 0.48). After the rebound three patients continued treatment with FTY, only one patient restarted NTZ.CONCLUSION:
Discontinuation of NTZ treatment may trigger a severe rebound with marked clinical and radiological worsening. A very careful evaluation of benefit-risk should be considered before NTZ withdrawal, and a close monitoring and a short washout period is recommended after drug withdrawal.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Multiple Sclerosis, Relapsing-Remitting
/
Drug Substitution
/
Natalizumab
/
Immunologic Factors
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Male
Language:
En
Journal:
Brain Behav
Year:
2017
Document type:
Article