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Immune cells after prolonged N atalizumab therapy: implications for effectiveness and safety
Author(s) -
Marousi S.,
Karkanis I.,
Kalamatas T.,
Travasarou M.,
Paterakis G.,
Karageorgiou C. E.
Publication year - 2013
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12080
Subject(s) - natalizumab , nat , multiple sclerosis , cd8 , medicine , immunology , immune system , cd4 cd8 ratio , fingolimod , gastroenterology , lymphocyte subsets , computer network , computer science
Background Previous studies on Natalizumab ( NAT ) have shown increased circulation of most white blood cells ( WBC ) in multiple sclerosis ( MS ) patients shortly after its introduction. Aim To describe peripheral immune cell phenotypes after more than 2 years of continuous NAT therapy and test for associations with clinical response to therapy. Methods Peripheral immune cell subsets were analyzed in 44 NAT ‐ MS patients receiving NAT for over 24 months, and in 22 NAT ‐free control‐ MS patients. Results NAT ‐ MS patients displayed significantly higher numbers of all WBC when compared with controls. B lymphocytes exhibited a more pronounced increase when compared with CD 4+, CD 8+ and NK T‐cells ( P = 0.011). CD 4/ CD 8 ratio was significantly decreased in NAT ‐ MS patients ( P = 0.018) and showed no correlation with the number of NAT doses. The reduced CD 4/ CD 8 ratio was attributable to the ‘ EDSS improvement’ group only, irrespective of age, sex and disease severity. Conclusions The study suggests that there is no desensitization effect after prolonged NAT exposure. A reduced CD 4/ CD 8 ratio was associated with long‐term response to therapy; thus, those patients who most benefitted from the drug might be at greater risk for opportunistic infections like progressive multifocal leucoencephalopathy ( PML ). We provide implications for future research for the CD 4/ CD 8 ratio as a possible contributor to the recently developed risk stratification scheme for PML .