Significant clinical worsening after natalizumab withdrawal: Predictive factors. (May 2015)

• Record Type: Journal Article
• Authors: Vidal-Jordana, A; Tintoré, M; Tur, C; Pérez-Miralles, F; Auger, C; Río, J; Nos, C; Arrambide, G; Comabella, M; Galán, I; Castilló, J; Sastre-Garriga, J; Rovira, A; Montalban, X
• Is Part Of: Multiple sclerosis. Volume 21:Number 6(2015)
• Page Start: 780
• Page End: 785
• Publication Date: 2015-05
• Subjects: Clinical worsening -- drug withdrawal -- magnetic resonance imaging -- multiple sclerosis -- natalizumab -- rebound effect -- responsiveness; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458514549401
• Languages: English
• ISSNs: 1352-4585

Abstract

We aimed to single out multiple sclerosis (MS) cases with poor outcome after natalizumab withdrawal and to identify predictive variables. We ascertained 47 withdrawals, and compared their pre- and post-natalizumab periods. We objectively defined significant clinical worsening after natalizumab withdrawal as a 2-step increase in Expanded Disability Status Scale (EDSS). We performed regression models. As a group, post-natalizumab annualized relapse rate (ARR) was lower in the post-natalizumab period, and there were no differences in the mean number of gadolinium (Gd)-enhancing lesions between pre- and post-natalizumab magnetic resonance imaging (MRI). Corticosteroid treatment did not change the outcomes. Eight patients (19%) presented significant clinical worsening after natalizumab withdrawal, which was predicted by a higher baseline EDSS and a 1-step EDSS increase while on natalizumab.