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High-Risk PML Patients Switching from Natalizumab to Alemtuzumab: an Observational Study

INTRODUCTION: The choice of therapy in patients withdrawing from natalizumab treatment is still an open question and neurologists need strategies to manage this group of patients. The aim of this study is to evaluate if alemtuzumab is able to control the disease when used in patient who have stopped...

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Autores principales: Malucchi, Simona, Capobianco, Marco, Lo Re, Marianna, Malentacchi, Maria, di Sapio, Alessia, Matta, Manuela, Sperli, Francesca, Bertolotto, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447551/
https://www.ncbi.nlm.nih.gov/pubmed/27915429
http://dx.doi.org/10.1007/s40120-016-0058-0
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author Malucchi, Simona
Capobianco, Marco
Lo Re, Marianna
Malentacchi, Maria
di Sapio, Alessia
Matta, Manuela
Sperli, Francesca
Bertolotto, Antonio
author_facet Malucchi, Simona
Capobianco, Marco
Lo Re, Marianna
Malentacchi, Maria
di Sapio, Alessia
Matta, Manuela
Sperli, Francesca
Bertolotto, Antonio
author_sort Malucchi, Simona
collection PubMed
description INTRODUCTION: The choice of therapy in patients withdrawing from natalizumab treatment is still an open question and neurologists need strategies to manage this group of patients. The aim of this study is to evaluate if alemtuzumab is able to control the disease when used in patient who have stopped natalizumab. METHODS: 16 patients stopped natalizumab treatment after a median number of 20 infusions (range 12–114); all the patients were responders to natalizumab (neither clinical nor radiological activity during natalizumab therapy) and the reason for stopping was the risk of PML for all of them. Patients were switched to alemtuzumab after a median wash-out period of 70 days (range 41–99 days); patients underwent brain MRI every three months during natalizumab treatment and then just before starting alemtuzumab in order to exclude signs suggestive of PML; then, contrast-enhanced brain MRI was planned 6 and 12 months after alemtuzumab infusion. RESULTS: At present, 8 out of 16 patients have a follow-up >6 months and 2 out of 8 reached 1-year follow-up; 5 have a follow-up of 3–6 months and 3 have a follow-up <3 months. Brain MRI at 6 months after alemtuzumab is available for 8 out of 16 patients and in all of them, neither signs of disease activity nor new lesions are present; in 2 out of 8 patients, brain MRI at 12 months is also available, showing no sign of disease activity. Clinical evaluation performed at 6 and at 12 months (when available) showed stability, in particular neither relapses nor increase in EDSS were observed. CONCLUSIONS: Alemtuzumab was able to control the disease course in patients who stopped natalizumab; of course, as this is a single-centre study and the number of patients is small, these findings are very preliminary and need further confirmation.
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spelling pubmed-54475512017-06-13 High-Risk PML Patients Switching from Natalizumab to Alemtuzumab: an Observational Study Malucchi, Simona Capobianco, Marco Lo Re, Marianna Malentacchi, Maria di Sapio, Alessia Matta, Manuela Sperli, Francesca Bertolotto, Antonio Neurol Ther Brief Report INTRODUCTION: The choice of therapy in patients withdrawing from natalizumab treatment is still an open question and neurologists need strategies to manage this group of patients. The aim of this study is to evaluate if alemtuzumab is able to control the disease when used in patient who have stopped natalizumab. METHODS: 16 patients stopped natalizumab treatment after a median number of 20 infusions (range 12–114); all the patients were responders to natalizumab (neither clinical nor radiological activity during natalizumab therapy) and the reason for stopping was the risk of PML for all of them. Patients were switched to alemtuzumab after a median wash-out period of 70 days (range 41–99 days); patients underwent brain MRI every three months during natalizumab treatment and then just before starting alemtuzumab in order to exclude signs suggestive of PML; then, contrast-enhanced brain MRI was planned 6 and 12 months after alemtuzumab infusion. RESULTS: At present, 8 out of 16 patients have a follow-up >6 months and 2 out of 8 reached 1-year follow-up; 5 have a follow-up of 3–6 months and 3 have a follow-up <3 months. Brain MRI at 6 months after alemtuzumab is available for 8 out of 16 patients and in all of them, neither signs of disease activity nor new lesions are present; in 2 out of 8 patients, brain MRI at 12 months is also available, showing no sign of disease activity. Clinical evaluation performed at 6 and at 12 months (when available) showed stability, in particular neither relapses nor increase in EDSS were observed. CONCLUSIONS: Alemtuzumab was able to control the disease course in patients who stopped natalizumab; of course, as this is a single-centre study and the number of patients is small, these findings are very preliminary and need further confirmation. Springer Healthcare 2016-12-03 /pmc/articles/PMC5447551/ /pubmed/27915429 http://dx.doi.org/10.1007/s40120-016-0058-0 Text en © The Author(s) 2016 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Brief Report
Malucchi, Simona
Capobianco, Marco
Lo Re, Marianna
Malentacchi, Maria
di Sapio, Alessia
Matta, Manuela
Sperli, Francesca
Bertolotto, Antonio
High-Risk PML Patients Switching from Natalizumab to Alemtuzumab: an Observational Study
title High-Risk PML Patients Switching from Natalizumab to Alemtuzumab: an Observational Study
title_full High-Risk PML Patients Switching from Natalizumab to Alemtuzumab: an Observational Study
title_fullStr High-Risk PML Patients Switching from Natalizumab to Alemtuzumab: an Observational Study
title_full_unstemmed High-Risk PML Patients Switching from Natalizumab to Alemtuzumab: an Observational Study
title_short High-Risk PML Patients Switching from Natalizumab to Alemtuzumab: an Observational Study
title_sort high-risk pml patients switching from natalizumab to alemtuzumab: an observational study
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447551/
https://www.ncbi.nlm.nih.gov/pubmed/27915429
http://dx.doi.org/10.1007/s40120-016-0058-0
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