Dr. Podolsky suggested that natalizumab therapy be targeted to patients with frequent and debilitating recurrences of inflammatory bowel disease, in concert with close surveillance by MRI, which may be able to identify the leukoencephalopathy complication at an early stage in patients who are still asymptomatic for this adverse effect.
The precedent exists for treating patients with more severe inflammatory bowel disease with other agents that can cause potentially life-threatening immunodeficiency, such as infliximab, said Dr. Podolsky, chief of gastroenterology at Massachusetts General Hospital in Boston.