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Natalizumab in Multiple Sclerosis: Long-Term Management
Natalizumab is a monoclonal antibody highly effective in the treatment of relapsing remitting multiple sclerosis (RRMS) patients. Despite its effectiveness, there are growing concerns regarding the risk of progressive multifocal leukoencephalopathy (PML), a brain infection caused by John Cunningham...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454853/ https://www.ncbi.nlm.nih.gov/pubmed/28468254 http://dx.doi.org/10.3390/ijms18050940 |
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author | Clerico, Marinella Artusi, Carlo Alberto Di Liberto, Alessandra Rolla, Simona Bardina, Valentina Barbero, Pierangelo De Mercanti, Stefania Federica Durelli, Luca |
author_facet | Clerico, Marinella Artusi, Carlo Alberto Di Liberto, Alessandra Rolla, Simona Bardina, Valentina Barbero, Pierangelo De Mercanti, Stefania Federica Durelli, Luca |
author_sort | Clerico, Marinella |
collection | PubMed |
description | Natalizumab is a monoclonal antibody highly effective in the treatment of relapsing remitting multiple sclerosis (RRMS) patients. Despite its effectiveness, there are growing concerns regarding the risk of progressive multifocal leukoencephalopathy (PML), a brain infection caused by John Cunningham virus (JCV), particularly after 24 doses and in patients who previously received immunosuppressive drugs. Long-term natalizumab treated, immunosuppressive-pretreated, and JCV antibody-positive patients are asked to rediscuss natalizumab continuation or withdrawal after 24 doses. Until now, there has not been a clear strategy that should be followed to avoid PML risk and in parallel reduce clinical and radiological rebound activity. In this review, we analyzed the results of clinical trials and case reports in relation to the following situations: natalizumab continuation, natalizumab discontinuation followed by full therapeutic suspension or switch to other first or second line MS treatments. Quitting all MS treatment after natalizumab increases MS activity occurrence. The results regarding the therapeutic switch are not homogeneous, so at the moment there are no established guidelines regarding natalizumab treatment after 24 administrations; the choice is currently based on the professional experience of the neurologist, and on patients’ clinical features and preferences. |
format | Online Article Text |
id | pubmed-5454853 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-54548532017-06-08 Natalizumab in Multiple Sclerosis: Long-Term Management Clerico, Marinella Artusi, Carlo Alberto Di Liberto, Alessandra Rolla, Simona Bardina, Valentina Barbero, Pierangelo De Mercanti, Stefania Federica Durelli, Luca Int J Mol Sci Review Natalizumab is a monoclonal antibody highly effective in the treatment of relapsing remitting multiple sclerosis (RRMS) patients. Despite its effectiveness, there are growing concerns regarding the risk of progressive multifocal leukoencephalopathy (PML), a brain infection caused by John Cunningham virus (JCV), particularly after 24 doses and in patients who previously received immunosuppressive drugs. Long-term natalizumab treated, immunosuppressive-pretreated, and JCV antibody-positive patients are asked to rediscuss natalizumab continuation or withdrawal after 24 doses. Until now, there has not been a clear strategy that should be followed to avoid PML risk and in parallel reduce clinical and radiological rebound activity. In this review, we analyzed the results of clinical trials and case reports in relation to the following situations: natalizumab continuation, natalizumab discontinuation followed by full therapeutic suspension or switch to other first or second line MS treatments. Quitting all MS treatment after natalizumab increases MS activity occurrence. The results regarding the therapeutic switch are not homogeneous, so at the moment there are no established guidelines regarding natalizumab treatment after 24 administrations; the choice is currently based on the professional experience of the neurologist, and on patients’ clinical features and preferences. MDPI 2017-04-29 /pmc/articles/PMC5454853/ /pubmed/28468254 http://dx.doi.org/10.3390/ijms18050940 Text en © 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Clerico, Marinella Artusi, Carlo Alberto Di Liberto, Alessandra Rolla, Simona Bardina, Valentina Barbero, Pierangelo De Mercanti, Stefania Federica Durelli, Luca Natalizumab in Multiple Sclerosis: Long-Term Management |
title | Natalizumab in Multiple Sclerosis: Long-Term Management |
title_full | Natalizumab in Multiple Sclerosis: Long-Term Management |
title_fullStr | Natalizumab in Multiple Sclerosis: Long-Term Management |
title_full_unstemmed | Natalizumab in Multiple Sclerosis: Long-Term Management |
title_short | Natalizumab in Multiple Sclerosis: Long-Term Management |
title_sort | natalizumab in multiple sclerosis: long-term management |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454853/ https://www.ncbi.nlm.nih.gov/pubmed/28468254 http://dx.doi.org/10.3390/ijms18050940 |
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