Open AccessTreatment Options to Reduce Disease Activity After Natalizumab: Paradoxical Effects of Corticosteroids
Author(s) -
Rossi Silvia,
Motta Caterina,
Studer Valeria,
Boffa Laura,
Chiara Valentina,
Castelli Maura,
Barbieri Francesca,
Buttari Fabio,
Monteleone Fabrizia,
Germani Giorgio,
Macchiarulo Giulia,
Weiss Sagit,
Centonze Diego
Publication year - 2014
Publication title -
cns neuroscience and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 69
eISSN - 1755-5949
pISSN - 1755-5930
DOI - 10.1111/cns.12282
Subject(s) - natalizumab , discontinuation , medicine , glatiramer acetate , multiple sclerosis , progressive multifocal leukoencephalopathy , gastroenterology , disease , immunology
Summary Aim Natalizumab ( NTZ ) discontinuation leads to multiple sclerosis ( MS ) recurrence, but represents the only known strategy to limit the risk of progressive multifocal leukoencephalopathy ( PML ) in JCV seropositive patients. Here, we compared the clinical and imaging features of three groups of patients who discontinued NTZ treatment. Methods We treated 25 patients with subcutaneous INF β‐1b ( INF group), 40 patients with glatiramer acetate (GA group), and 40 patients with GA plus pulse steroid ( GA + CS group). Results Six of 25 patients (24%) of the INF group were relapse‐free 6 months after NTZ suspension. In GA group, a significant higher proportion of patients (26 of 40 patients, 65%) were relapse‐free ( P < 0.05). Far from improving the clinical effects of GA in post‐ NTZ setting, combination of GA + CS was associated with lower relapse‐free rate than GA alone (40% vs. 65%, P = 0.04). Also on MRI parameters, combination of GA + CS was associated with worse outcome than GA alone, as 22 of 26 subjects (84.6%) had MRI evidence of disease activity 6 months after NTZ discontinuation. Conclusion Corticosteroids should not be used in combination with GA to prevent post‐ NTZ disease recurrence.