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Background and purpose  Impaired ambulation is a prominent disabling symptom of multiple sclerosis and can lead to reduced quality of life. Whether natalizumab, a monoclonal antibody shown to reduce disease activity in relapsing−remitting multiple sclerosis, could impact ambulation performance was examined.    Methods  A prospective open‐label study,  TIMER , was conducted in natalizumab‐naive patients ( n  =   215). The timed 25‐foot walk ( T 25 FW ) and timed 100‐m walk ( T 100 MW ) were assessed at baseline and at weeks 24 and 48 of natalizumab therapy, together with  E xpanded  D isability  S tatus  S cale scores. The effects of natalizumab on  T 25 FW  performance were also examined in a retrospective analysis of natalizumab‐treated patients ( n  =   627) and placebo control patients ( n  =   315) from the  AFFIRM  study.    Results  In  TIMER , a significant increase from baseline in  T 25 FW  speed was seen at week 24 ( P  =   0.0074) and in  T 100 MW  speed at weeks 24 and 48 (both  P  <   0.001). A greater proportion of patients showed clinically meaningful increases (≥20%) in walking speed on the  T 100 MW  (25%) than on the  T 25 FW  (13%) at week 48 ( P  =   0.032). In  AFFIRM , natalizumab increased the proportion of patients with ≥20% confirmed improvement in  T 25 FW  speed at year 2 by 78% versus placebo ( P  =   0.0133).    Conclusions  Natalizumab increased walking speed in patients with relapsing−remitting multiple sclerosis. The  T 100 MW  may be more sensitive to changes in ambulation capacity than the  T 25 FW , and both tests appear to detect clinically meaningful improvements in ambulatory function.

european journal of neurology

Natalizumab improves ambulation in relapsing−remitting multiple sclerosis: results from the prospective  TIMER  study and a retrospective analysis of  AFFIRM