Author Topic: (Abst.) What to expect after stopping Tysabri...  (Read 147 times)

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Offline agate

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(Abst.) What to expect after stopping Tysabri...
« on: April 30, 2014, 04:32:55 pm »
From PubMed via NTK Watch, April 30, 2014:

Quote
Acta Neurol Scand. 2014 Apr 10.

What to expect after natalizumab cessation in a real-life setting

Salhofer-Polanyi S1, Baumgartner A, Kraus J, Maida E, Schmied M, Leutmezer F.

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1Department of Neurology, Medical University of Vienna, Vienna, Austria.

BACKGROUND:

To minimize the risk of progressive multifocal leucoencephalopathy (PML), treatment with natalizumab is often stopped after 2 years, but evidence upon rebound of disease activity is limited and controversial.

OBJECTIVE:

To evaluate effects of natalizumab discontinuation on clinical disease activity within twelve months after cessation.

METHODS:

We retrospectively analyzed data of 201 patients with MS who discontinued natalizumab between 2007 and 2012. Mean change scores of annualized relapse rate (ARR) and expanded disability status scale (EDSS) were calculated for detection of rebound disease activity after twelve months.

RESULTS:

Natalizumab exposure did not exceed 2 years in 50.2% of patients, and the most common reasons for discontinuation were a long treatment period and concern of PML (56%). A total of 11.9% experienced a rebound phenomenon within twelve months. Mean ARR prenatalizumab was lower (P = 0.001, 95% CI -1.0-0.000) and treatment response to natalizumab poorer (P < 0.001, 95% CI 0.4-1.3) in patients with rebound compared to those without, but rebound was not associated with brief exposure to natalizumab (P = 0.159, 95% CI -9.3-1.5). 86.1% of patients switched to another therapy. Patients without rebound were found more often in the group starting an alternative treatment early (P = 0.013).

CONCLUSION:

Our data suggest that rebound of MS disease activity affects a subgroup of patients (11.9%), especially those with low disease activity before natalizumab therapy and a longer treatment gap after its withdrawal.

PMID: 24720783

The abstract can be seen here.
« Last Edit: April 30, 2014, 04:39:36 pm by agate »
MS Speaks--online for 17 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.

Offline agate

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Re: (Abst.) What to expect after stopping Tysabri...
« Reply #1 on: December 10, 2014, 03:51:51 pm »
Another article on MS worsening after stopping Tysabri.

From NTK Institute as it appeared in PubMed, December 10, 2014:

Quote
Mult Scler. 2014 Nov 12.

Significant clinical worsening after natalizumab withdrawal: Predictive factors

Vidal-Jordana A1, Tintoré M1, Tur C1, Pérez-Miralles F1, Auger C1, Río J1, Nos C1, Arrambide G1, Comabella M1, Galán I1, Castilló J1, Sastre-Garriga J1, Rovira A1, Montalban X2.

Author information

1Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
2Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain xmontalban@cem-cat.org.

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.
MS Speaks--online for 17 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.