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Failure of natalizumab to prevent relapses in neuromyelitis optica

Item Type:Article
Title:Failure of natalizumab to prevent relapses in neuromyelitis optica
Creators Name:Kleiter, I. and Hellwig, K. and Berthele, A. and Kuempfel, T. and Linker, R.A. and Hartung, H.P. and Paul, F. and Aktas, O.
Abstract:Objective: To describe first experiences with the integrin inhibitor natalizumab, given to patients with suspected relapsing-remitting multiple sclerosis (MS) who were later diagnosed with aquaporin 4–positive neuromyelitis optica (NMO). Design: Retrospective case series. Setting: Neurology departments at tertiary referral centers in Germany. Patients: Patients with NMO who tested positive for antibodies to aquaporin 4. Intervention: Treatment with natalizumab. Main Outcome Measures: Relapses and accumulation of disability. Results: We identified 5 patients (4 female; median age, 45 years) who were initially diagnosed with MS and treated with natalizumab before diagnosis of NMO was established. Natalizumab was given as escalation therapy after failure of first- or second-line immunomodulatory therapies for MS. During natalizumab therapy (median duration, 8 infusions; range, 2-11 infusions), all 5 patients displayed persisting disease activity; a total of 9 relapses occurred (median duration to relapse, 120 days; range, 45-230 days) after the start of treatment. Four patients had an accumulation of disability and 1 patient died 2 months after cessation of natalizumab treatment. Conclusions: Our results suggest that natalizumab fails to control disease activity in patients with NMO. Neuromyelitis optica should be considered as a differential diagnosis in patients with suspected MS who are unresponsive to natalizumab therapy.
Keywords:Aquaporin 4, Autoantibodies, Disability Evaluation, Humanized Monoclonal Antibodies, Natalizumab, Neuromyelitis Optica, Relapsing-Remitting Multiple Sclerosis, Secondary Prevention, Treatment Failure, Treatment Outcome
Source:Archives of Neurology
Page Range:239-245
Date:February 2012
Official Publication:https://doi.org/10.1001/archneurol.2011.216
PubMed:View item in PubMed

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