Experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years

Abstract Natalizumab (NTZ) has been used for treatment of highly active relapsing–remitting multiple sclerosis (MS). When stopping NTZ the risk of severe rebound phenomenon has to be considered. We aimed to investigate the use of NTZ in clinical routine and focused on identification of potential ris...

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Autores principales:	Michael Auer, Anne Zinganell, Harald Hegen, Gabriel Bsteh, Franziska Di Pauli, Klaus Berek, Elena Fava, Sebastian Wurth, Thomas Berger, Florian Deisenhammer
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c9d665bf8d6647dd880506272321e181
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spelling	oai:doaj.org-article:c9d665bf8d6647dd880506272321e1812021-12-05T12:16:13ZExperiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years10.1038/s41598-021-02665-62045-2322https://doaj.org/article/c9d665bf8d6647dd880506272321e1812021-12-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-02665-6https://doaj.org/toc/2045-2322Abstract Natalizumab (NTZ) has been used for treatment of highly active relapsing–remitting multiple sclerosis (MS). When stopping NTZ the risk of severe rebound phenomenon has to be considered. We aimed to investigate the use of NTZ in clinical routine and focused on identification of potential risk factors for disease reactivation after treatment discontinuation. At the Medical University of Innsbruck, Austria, we identified all MS patients who were treated with NTZ and performed a retrospective analysis on therapeutic decision making, disease course before, during and after treatment with NTZ and on risk factors for disease reactivation after NTZ discontinuation. 235 NTZ treated MS patients were included, of whom 105 had discontinued treatment. At NTZ start disease duration was 5.09 (IQR 2.09–10.57) years, average number of total relapses was 4 (IQR 3–6) and median EDSS 2.0 (range 0–6.5), whereby these values significantly decreased over time. Reduction of annualized relapse rate (ARR) on treatment was 93% and EDSS remained stable in 64%. In multivariate regression models only conversion to secondary progressive MS (SPMS) on treatment was significantly associated with lower risk of disease reactivation after NTZ, while ARR before treatment was associated with earlier disease reactivation. We could confirm the high therapeutic efficacy of NTZ which trends to be used earlier in the disease course nowadays. Discontinuation of NTZ seems safe only in patients who convert to SPMS during treatment, while higher ARR before NTZ increases the risk of disease reactivation after treatment discontinuation.Michael AuerAnne ZinganellHarald HegenGabriel BstehFranziska Di PauliKlaus BerekElena FavaSebastian WurthThomas BergerFlorian DeisenhammerNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Michael Auer Anne Zinganell Harald Hegen Gabriel Bsteh Franziska Di Pauli Klaus Berek Elena Fava Sebastian Wurth Thomas Berger Florian Deisenhammer Experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years
description	Abstract Natalizumab (NTZ) has been used for treatment of highly active relapsing–remitting multiple sclerosis (MS). When stopping NTZ the risk of severe rebound phenomenon has to be considered. We aimed to investigate the use of NTZ in clinical routine and focused on identification of potential risk factors for disease reactivation after treatment discontinuation. At the Medical University of Innsbruck, Austria, we identified all MS patients who were treated with NTZ and performed a retrospective analysis on therapeutic decision making, disease course before, during and after treatment with NTZ and on risk factors for disease reactivation after NTZ discontinuation. 235 NTZ treated MS patients were included, of whom 105 had discontinued treatment. At NTZ start disease duration was 5.09 (IQR 2.09–10.57) years, average number of total relapses was 4 (IQR 3–6) and median EDSS 2.0 (range 0–6.5), whereby these values significantly decreased over time. Reduction of annualized relapse rate (ARR) on treatment was 93% and EDSS remained stable in 64%. In multivariate regression models only conversion to secondary progressive MS (SPMS) on treatment was significantly associated with lower risk of disease reactivation after NTZ, while ARR before treatment was associated with earlier disease reactivation. We could confirm the high therapeutic efficacy of NTZ which trends to be used earlier in the disease course nowadays. Discontinuation of NTZ seems safe only in patients who convert to SPMS during treatment, while higher ARR before NTZ increases the risk of disease reactivation after treatment discontinuation.
format	article
author	Michael Auer Anne Zinganell Harald Hegen Gabriel Bsteh Franziska Di Pauli Klaus Berek Elena Fava Sebastian Wurth Thomas Berger Florian Deisenhammer
author_facet	Michael Auer Anne Zinganell Harald Hegen Gabriel Bsteh Franziska Di Pauli Klaus Berek Elena Fava Sebastian Wurth Thomas Berger Florian Deisenhammer
author_sort	Michael Auer
title	Experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years
title_short	Experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years
title_full	Experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years
title_fullStr	Experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years
title_full_unstemmed	Experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years
title_sort	experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/c9d665bf8d6647dd880506272321e181
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Experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years

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