Natalizumab treatment for multiple sclerosis: updated recommendations for patient selection and monitoring

@article{Kappos2011NatalizumabTF,
  title={Natalizumab treatment for multiple sclerosis: updated recommendations for patient selection and monitoring},
  author={Ludwig Kappos and David W. Bates and Gilles Edan and Mefkure Eraksoy and Antonio Garc{\'i}a-Merino and Nikolaos Grigoriadis and H. P. Hartung and Eva Kubala Havrdov{\'a} and Jan Hillert and Reinhard Hohlfeld and Marcelo Kremenchutzky and Olivier Lyon-Caen and Ariel Miller and Carlo Pozzilli and Mads Henrik Ravnborg and Takahiko Saida and Christian J. M. Sindic and Karl Vass and David B. Clifford and Stephen Hauser and Eugene O. Major and P. W. O'Connor and Howard L. Weiner and Michel Clanet and Ralf Gold and Hans H. Hirsch and Ernst Wilhelm Rad{\"u} and Per Soelberg S{\o}rensen and John O King},
  journal={The Lancet Neurology},
  year={2011},
  volume={10},
  pages={745-758}
}
Natalizumab, a highly specific α4-integrin antagonist, is approved for treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). It is generally recommended for individuals who have not responded to a currently available first-line disease-modifying therapy or who have very active disease. The expected benefits of natalizumab treatment have to be weighed against risks, especially the rare but serious adverse event of progressive multifocal leukoencephalopathy. In this… 
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TLDR
The data indicate that natalizumab may be safe and effective against MS in pediatric patients with breakthrough disease.
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Initial observations in 10 multiple sclerosis patients who were stringently monitored up to 6 months after discontinuation of the infusions suggest that in patients who was switched to natalizumab because of disease activity despite first‐line treatment, a natalIZumab drug holiday without reinstatement of alternate disease‐modifying therapy is poorly tolerated.
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Recommendations have been developed to guide neurologists in the Middle East and North Africa on patient selection for natalizumab treatment and monitoring and the risk-benefit ratio should be reassessed and discussed with patients.
Natalizumab treatment for multiple sclerosis: Middle East and North Africa regional recommendations for patient selection and monitoring
TLDR
Recommendations have been developed to guide neurologists in the Middle East and North Africa on patient selection for natalizumab treatment and monitoring and the risk-benefit ratio should be reassessed and discussed with patients.
Natalizumab and progressive multifocal leukoencephalopathy: what are the causal factors and can it be avoided?
TLDR
There is currently no convincing evidence that natalizumab-associated PML is restricted to combination therapy with other disease-modifying or immunosuppressive agents.
A review of the evidence for a natalizumab exit strategy for patients with multiple sclerosis.
TLDR
The evidence suggests that the washout period between natalizumab and fingolimod should not exceed 12 weeks, and the limited evidence available for rituximab and alemtuzumab is promising, and further data on these and other newer therapies for RRMS are awaited.
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Natalizumab treatment for multiple sclerosis: recommendations for patient selection and monitoring
TLDR
A three-step diagnostic and management algorithm was developed to monitor natalizumab-treated patients with multiple sclerosis for PML and other opportunistic infections, thereby increasing the opportunity for immune reconstitution, which may improve prognosis if PML is confirmed.
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TLDR
The patient was hospitalized 2 months after the onset of neurologic and psychiatric symptoms and was treated with plasma exchange and immunoadsorption to eliminate natalizumab, and became critically ill with an apparent episode of immune reconstitution inflammatory syndrome.
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TLDR
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TLDR
Despite that the baseline characteristics suggested a more severe course of disease in the sample than that of the AFFIRM trial, data on effectiveness of natalizumab were comparable and the presence of antibodies anti-Natalizuab was strongly related to the occurrence of relapses even in the post-marketing experience.
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TLDR
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TLDR
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TLDR
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TLDR
A patient who developed dramatic clinical and radiologic worsening as a consequence of natalizumab withdrawal after prolonged therapy is reported, which was reminiscent of an immune reconstitution inflammatory syndrome (IRIS).
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TLDR
Two articles in this issue of Annals provide the first detailed look at immunological effects of natalizumab treatment in patients with MS, and demonstrate that treatment dramatically reduces the number of cerebrospinal fluid mononuclear cells.
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