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Fingolimod reduces recurrence of disease activity after natalizumab withdrawal in multiple sclerosis.
J Neurol 2013; 260(5):1382-7JN

Abstract

After discontinuation of natalizumab (NAT), multiple sclerosis (MS) disease activity often recurs. We assessed the recurrence of clinical disease activity during the first year after switching from NAT to fingolimod (FTY) in patients with relapsing-remitting MS. The number of relapses and the annualized relapse rate (ARR) before, during and after NAT discontinuation were determined and compared between 26 MS patients who switched to FTY within 24 weeks, and 10 MS patients who remained without disease modifying therapy (therapy free group = TFG). Median follow-up post-NAT discontinuation was 55.1 weeks. In a subgroup (n = 20), the occurrence of contrast-enhancing-lesions (Gd+) on magnetic resonance imaging (MRI) was determined. Eleven patients (42 %) in the FTY group and seven patients (70 %) in the TFG had one or more relapses after cessation of NAT during follow-up (p < 0.05). One of the 11 (9 %) patients in the FTY group and 6/9 (67 %) patients in the TFG showed Gd+ lesions during follow-up (p < 0.05). Patients who switched to FTY ≤ 12 weeks after NAT discontinuation (n = 9) showed a trend for a lower post-NAT ARR compared to patients who started FTY therapy >12 weeks after NAT was stopped (n = 17). Most relapses in the FTY group occurred just before or within 8 weeks after starting FTY. Our observation suggests that initiation of FTY treatment after NAT discontinuation reduces the recurrence of disease activity compared to withdrawal without further immunomodulatory treatment. In the FTY group the ARR tended to depend on the time interval between discontinuation of NAT and initiation of FTY.

Authors+Show Affiliations

Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany. joachim.havla@med.lmu.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23266894

Citation

Havla, Joachim, et al. "Fingolimod Reduces Recurrence of Disease Activity After Natalizumab Withdrawal in Multiple Sclerosis." Journal of Neurology, vol. 260, no. 5, 2013, pp. 1382-7.
Havla J, Tackenberg B, Hellwig K, et al. Fingolimod reduces recurrence of disease activity after natalizumab withdrawal in multiple sclerosis. J Neurol. 2013;260(5):1382-7.
Havla, J., Tackenberg, B., Hellwig, K., Meinl, I., Krumbholz, M., Seitz, F., ... Kümpfel, T. (2013). Fingolimod reduces recurrence of disease activity after natalizumab withdrawal in multiple sclerosis. Journal of Neurology, 260(5), pp. 1382-7. doi:10.1007/s00415-012-6808-8.
Havla J, et al. Fingolimod Reduces Recurrence of Disease Activity After Natalizumab Withdrawal in Multiple Sclerosis. J Neurol. 2013;260(5):1382-7. PubMed PMID: 23266894.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fingolimod reduces recurrence of disease activity after natalizumab withdrawal in multiple sclerosis. AU - Havla,Joachim, AU - Tackenberg,Björn, AU - Hellwig,Kerstin, AU - Meinl,Ingrid, AU - Krumbholz,Markus, AU - Seitz,Florian, AU - Eienbröker,Christian, AU - Gold,Ralf, AU - Hohlfeld,Reinhard, AU - Kleiter,Ingo, AU - Kümpfel,Tania, Y1 - 2012/12/25/ PY - 2012/11/09/received PY - 2012/12/14/accepted PY - 2012/12/07/revised PY - 2012/12/26/entrez PY - 2012/12/26/pubmed PY - 2013/12/16/medline SP - 1382 EP - 7 JF - Journal of neurology JO - J. Neurol. VL - 260 IS - 5 N2 - After discontinuation of natalizumab (NAT), multiple sclerosis (MS) disease activity often recurs. We assessed the recurrence of clinical disease activity during the first year after switching from NAT to fingolimod (FTY) in patients with relapsing-remitting MS. The number of relapses and the annualized relapse rate (ARR) before, during and after NAT discontinuation were determined and compared between 26 MS patients who switched to FTY within 24 weeks, and 10 MS patients who remained without disease modifying therapy (therapy free group = TFG). Median follow-up post-NAT discontinuation was 55.1 weeks. In a subgroup (n = 20), the occurrence of contrast-enhancing-lesions (Gd+) on magnetic resonance imaging (MRI) was determined. Eleven patients (42 %) in the FTY group and seven patients (70 %) in the TFG had one or more relapses after cessation of NAT during follow-up (p < 0.05). One of the 11 (9 %) patients in the FTY group and 6/9 (67 %) patients in the TFG showed Gd+ lesions during follow-up (p < 0.05). Patients who switched to FTY ≤ 12 weeks after NAT discontinuation (n = 9) showed a trend for a lower post-NAT ARR compared to patients who started FTY therapy >12 weeks after NAT was stopped (n = 17). Most relapses in the FTY group occurred just before or within 8 weeks after starting FTY. Our observation suggests that initiation of FTY treatment after NAT discontinuation reduces the recurrence of disease activity compared to withdrawal without further immunomodulatory treatment. In the FTY group the ARR tended to depend on the time interval between discontinuation of NAT and initiation of FTY. SN - 1432-1459 UR - https://www.unboundmedicine.com/medline/citation/23266894/Fingolimod_reduces_recurrence_of_disease_activity_after_natalizumab_withdrawal_in_multiple_sclerosis_ L2 - https://dx.doi.org/10.1007/s00415-012-6808-8 DB - PRIME DP - Unbound Medicine ER -