A tapered approach to natalizumab discontinuation reduced the risk of multiple sclerosis (MS) relapse within 12 months of discontinuation, according to Dr. Bianca Weinstock-Guttman and her associates.
From a group of 50 patients with relapsing MS discontinuing natalizumab, 23 received two subsequent natalizumab infusions before beginning another disease-modifying therapy, while the remaining 27 began a new disease-modifying therapy immediately. In the tapered-discontinuation group, eight relapses were seen in the following 12 months, seven of which occurred within the first 3 months. In the immediate-discontinuation group, 28 relapses were seen, 20 of which occurred within 3 months.
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A higher number of new T2 lesions were seen in the immediate-discontinuation group, compared with the tapered group, as well as a higher mean T2 lesion volume change after 12 months, and a higher number of new T1 hypointense lesions.
“Receptor saturation may be more relevant to natalizumab effectiveness than natalizumab serum concentration. Based on our study, we postulate that tapering the infusions, instead of immediate discontinuation, may provide a slower rate for VLA4 desaturation that may be of clinical importance,” the investigators noted.
Find the full study in the Journal of Neurology, Neurosurgery & Psychiatry (doi: 10.1136/jnnp-2015-312221).