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Natalizumab treatment for multiple sclerosis: recommendations for patient selection and monitoring

Lookup NU author(s): Emeritus Professor David Bates

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Abstract

Natalizumab is a new treatment option for patients with active relapsing-remitting multiple sclerosis. In phase III studies, natalizumab was highly effective and well tolerated; however, three cases of progressive multifocal leucoencephalopathy (PML) were identified (estimated incidence of one per 1000; 95% CI 0.2-2.8; mean treatment period 17.9 months). In this Review we summarise the current information on PML, the three confirmed cases of PML, and the results of an extensive safety assessment of all patients treated with natalizumab. On the basis of these reviews, we make recommendations for appropriate selection of candidates for natalizumab and pretreatment assessments. In addition, a three-step diagnostic and management algorithm was developed to monitor natalizumab-treated patients with multiple sclerosis for PML and other opportunistic infections. The algorithm includes strategies for clinical, MRI, and laboratory assessments. Maintaining clinical vigilance allows for early suspension of natalizumab in potential cases of PML, thereby increasing the opportunity for immune reconstitution, which may improve prognosis if PML is confirmed.


Publication metadata

Author(s): Kappos L, Bates D, Hartung HP, Havrdova E, Miller D, Polman CH, Ravnborg M, Houser SL, Rudick RA, Weiner HL, O'Connor PW, King J, Radue EW, Yousry T, Major E, Clifford DB

Publication type: Review

Publication status: Published

Journal: Lancet Neurology

Year: 2007

Volume: 6

Issue: 5

Pages: 431-441

ISSN (print): 1474-4422

ISSN (electronic): 1474-4465

URL: http://dx.doi.org/10.1016/S1474-4422(07)70078-9

DOI: 10.1016/S1474-4422(07)70078-9


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