Switching natalizumab to fingolimod within 6 weeks reduces recurrence of disease activity in MS patients

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Natalizumab is an effective treatment in relapsing-remitting multiple sclerosis (MS). Mainly because of the risk of progressive multifocal leukoencephalopathy (PML), a substantial proportion of John Cunningham (JC) virus-positive patients switch to fingolimod. Previous reports show a clear benefit when the duration of a washout (WO) period of natalizumab is 0-3 months in comparison to longer WO periods. However, there is no consensus regarding the optimal duration of a WO period under 3 months.

OBJECTIVE: We compared MS disease activity after different WO periods. In addition, we investigated several factors that possibly influence recurrence of disease activity, including serum natalizumab concentration and lymphocyte counts.

METHODS: From a prospective observational cohort study of natalizumab-treated patients, we selected 52 patients who switched to fingolimod. We divided the patients in three groups (<6 weeks, 6-8 weeks, >8 weeks WO). Serum natalizumab concentration and lymphocyte count were assessed during and after natalizumab treatment.

RESULTS: Patients with a WO period of >8 weeks had a significant higher recurrence of disease activity (odds ratio, 6.8; 95% confidence interval, 1.4-32.8) compared to patients with a WO period of <6 weeks. Serum natalizumab concentration and lymphocyte count did not predict recurrence of disease activity.

INTERPRETATION: A short WO period decreases the risk of recurrence of disease activity. The possible impact of a short WO period on the risk of carry-over PML in JC virus-positive patients remains uncertain.

Original languageEnglish
Pages (from-to)1453-1460
JournalMultiple Sclerosis
Volume24
Issue number11
DOIs
Publication statusPublished - Oct 2018

Cite this

@article{98aac71d1d1d49bd827c55a5a98356d7,
title = "Switching natalizumab to fingolimod within 6 weeks reduces recurrence of disease activity in MS patients",
abstract = "BACKGROUND: Natalizumab is an effective treatment in relapsing-remitting multiple sclerosis (MS). Mainly because of the risk of progressive multifocal leukoencephalopathy (PML), a substantial proportion of John Cunningham (JC) virus-positive patients switch to fingolimod. Previous reports show a clear benefit when the duration of a washout (WO) period of natalizumab is 0-3 months in comparison to longer WO periods. However, there is no consensus regarding the optimal duration of a WO period under 3 months.OBJECTIVE: We compared MS disease activity after different WO periods. In addition, we investigated several factors that possibly influence recurrence of disease activity, including serum natalizumab concentration and lymphocyte counts.METHODS: From a prospective observational cohort study of natalizumab-treated patients, we selected 52 patients who switched to fingolimod. We divided the patients in three groups (<6 weeks, 6-8 weeks, >8 weeks WO). Serum natalizumab concentration and lymphocyte count were assessed during and after natalizumab treatment.RESULTS: Patients with a WO period of >8 weeks had a significant higher recurrence of disease activity (odds ratio, 6.8; 95{\%} confidence interval, 1.4-32.8) compared to patients with a WO period of <6 weeks. Serum natalizumab concentration and lymphocyte count did not predict recurrence of disease activity.INTERPRETATION: A short WO period decreases the risk of recurrence of disease activity. The possible impact of a short WO period on the risk of carry-over PML in JC virus-positive patients remains uncertain.",
keywords = "Journal Article",
author = "Leurs, {Cyra E} and {van Kempen}, {Zo{\'e} LE} and Iris Dekker and Balk, {Lisanne J} and Wattjes, {Mike P} and Theo Rispens and Uitdehaag, {Bernard Mj} and Joep Killestein",
year = "2018",
month = "10",
doi = "10.1177/1352458517726381",
language = "English",
volume = "24",
pages = "1453--1460",
journal = "Multiple Sclerosis",
issn = "1352-4585",
publisher = "SAGE Publications Ltd",
number = "11",

}

Switching natalizumab to fingolimod within 6 weeks reduces recurrence of disease activity in MS patients. / Leurs, Cyra E; van Kempen, Zoé LE; Dekker, Iris; Balk, Lisanne J; Wattjes, Mike P; Rispens, Theo; Uitdehaag, Bernard Mj; Killestein, Joep.

In: Multiple Sclerosis, Vol. 24, No. 11, 10.2018, p. 1453-1460.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Switching natalizumab to fingolimod within 6 weeks reduces recurrence of disease activity in MS patients

AU - Leurs, Cyra E

AU - van Kempen, Zoé LE

AU - Dekker, Iris

AU - Balk, Lisanne J

AU - Wattjes, Mike P

AU - Rispens, Theo

AU - Uitdehaag, Bernard Mj

AU - Killestein, Joep

PY - 2018/10

Y1 - 2018/10

N2 - BACKGROUND: Natalizumab is an effective treatment in relapsing-remitting multiple sclerosis (MS). Mainly because of the risk of progressive multifocal leukoencephalopathy (PML), a substantial proportion of John Cunningham (JC) virus-positive patients switch to fingolimod. Previous reports show a clear benefit when the duration of a washout (WO) period of natalizumab is 0-3 months in comparison to longer WO periods. However, there is no consensus regarding the optimal duration of a WO period under 3 months.OBJECTIVE: We compared MS disease activity after different WO periods. In addition, we investigated several factors that possibly influence recurrence of disease activity, including serum natalizumab concentration and lymphocyte counts.METHODS: From a prospective observational cohort study of natalizumab-treated patients, we selected 52 patients who switched to fingolimod. We divided the patients in three groups (<6 weeks, 6-8 weeks, >8 weeks WO). Serum natalizumab concentration and lymphocyte count were assessed during and after natalizumab treatment.RESULTS: Patients with a WO period of >8 weeks had a significant higher recurrence of disease activity (odds ratio, 6.8; 95% confidence interval, 1.4-32.8) compared to patients with a WO period of <6 weeks. Serum natalizumab concentration and lymphocyte count did not predict recurrence of disease activity.INTERPRETATION: A short WO period decreases the risk of recurrence of disease activity. The possible impact of a short WO period on the risk of carry-over PML in JC virus-positive patients remains uncertain.

AB - BACKGROUND: Natalizumab is an effective treatment in relapsing-remitting multiple sclerosis (MS). Mainly because of the risk of progressive multifocal leukoencephalopathy (PML), a substantial proportion of John Cunningham (JC) virus-positive patients switch to fingolimod. Previous reports show a clear benefit when the duration of a washout (WO) period of natalizumab is 0-3 months in comparison to longer WO periods. However, there is no consensus regarding the optimal duration of a WO period under 3 months.OBJECTIVE: We compared MS disease activity after different WO periods. In addition, we investigated several factors that possibly influence recurrence of disease activity, including serum natalizumab concentration and lymphocyte counts.METHODS: From a prospective observational cohort study of natalizumab-treated patients, we selected 52 patients who switched to fingolimod. We divided the patients in three groups (<6 weeks, 6-8 weeks, >8 weeks WO). Serum natalizumab concentration and lymphocyte count were assessed during and after natalizumab treatment.RESULTS: Patients with a WO period of >8 weeks had a significant higher recurrence of disease activity (odds ratio, 6.8; 95% confidence interval, 1.4-32.8) compared to patients with a WO period of <6 weeks. Serum natalizumab concentration and lymphocyte count did not predict recurrence of disease activity.INTERPRETATION: A short WO period decreases the risk of recurrence of disease activity. The possible impact of a short WO period on the risk of carry-over PML in JC virus-positive patients remains uncertain.

KW - Journal Article

U2 - 10.1177/1352458517726381

DO - 10.1177/1352458517726381

M3 - Article

VL - 24

SP - 1453

EP - 1460

JO - Multiple Sclerosis

JF - Multiple Sclerosis

SN - 1352-4585

IS - 11

ER -