TY - JOUR
T1 - Treatment Options to Reduce Disease Activity After Natalizumab
T2 - Paradoxical Effects of Corticosteroids
AU - Rossi, Silvia
AU - Motta, Caterina
AU - Studer, Valeria
AU - Boffa, Laura
AU - De Chiara, Valentina
AU - Castelli, Maura
AU - Barbieri, Francesca
AU - Buttari, Fabio
AU - Monteleone, Fabrizia
AU - Germani, Giorgio
AU - Macchiarulo, Giulia
AU - Weiss, Sagit
AU - Centonze, Diego
PY - 2014
Y1 - 2014
N2 - Aim: Natalizumab (NTZ) discontinuation leads to multiple sclerosis (MS) recurrence, but represents the only known strategy to limit the risk of progressive multifocal leukoencephalopathy (PML) in JCV seropositive patients. Here, we compared the clinical and imaging features of three groups of patients who discontinued NTZ treatment. Methods: We treated 25 patients with subcutaneous INFβ-1b (INF group), 40 patients with glatiramer acetate (GA group), and 40 patients with GA plus pulse steroid (GA+CS group). Results: Six of 25 patients (24%) of the INF group were relapse-free 6 months after NTZ suspension. In GA group, a significant higher proportion of patients (26 of 40 patients, 65%) were relapse-free (P <0.05). Far from improving the clinical effects of GA in post-NTZ setting, combination of GA+CS was associated with lower relapse-free rate than GA alone (40% vs. 65%, P = 0.04). Also on MRI parameters, combination of GA+CS was associated with worse outcome than GA alone, as 22 of 26 subjects (84.6%) had MRI evidence of disease activity 6 months after NTZ discontinuation. Conclusion: Corticosteroids should not be used in combination with GA to prevent post-NTZ disease recurrence.
AB - Aim: Natalizumab (NTZ) discontinuation leads to multiple sclerosis (MS) recurrence, but represents the only known strategy to limit the risk of progressive multifocal leukoencephalopathy (PML) in JCV seropositive patients. Here, we compared the clinical and imaging features of three groups of patients who discontinued NTZ treatment. Methods: We treated 25 patients with subcutaneous INFβ-1b (INF group), 40 patients with glatiramer acetate (GA group), and 40 patients with GA plus pulse steroid (GA+CS group). Results: Six of 25 patients (24%) of the INF group were relapse-free 6 months after NTZ suspension. In GA group, a significant higher proportion of patients (26 of 40 patients, 65%) were relapse-free (P <0.05). Far from improving the clinical effects of GA in post-NTZ setting, combination of GA+CS was associated with lower relapse-free rate than GA alone (40% vs. 65%, P = 0.04). Also on MRI parameters, combination of GA+CS was associated with worse outcome than GA alone, as 22 of 26 subjects (84.6%) had MRI evidence of disease activity 6 months after NTZ discontinuation. Conclusion: Corticosteroids should not be used in combination with GA to prevent post-NTZ disease recurrence.
KW - Glatiramer acetate
KW - Immunomodulation
KW - JC virus
KW - PML
KW - Relapse
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U2 - 10.1111/cns.12282
DO - 10.1111/cns.12282
M3 - Article
C2 - 24837039
AN - SCOPUS:84904640150
VL - 20
SP - 748
EP - 753
JO - CNS Neuroscience and Therapeutics
JF - CNS Neuroscience and Therapeutics
SN - 1755-5930
IS - 8
ER -