ArticleNeurology and therapy2015
Natalizumab Discontinuation and Treatment Strategies in Patients with Multiple Sclerosis (MS): A Retrospective Study from Two Italian MS Centers.
Article in Neurology and therapy, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Rituximab for people with multiple sclerosis.The Cochrane database of systematic reviews · 2025Pooled it
- Rituximab for people with multiple sclerosis.The Cochrane database of systematic reviews · 2021Pooled it
- Effectiveness of Rituximab in rElapsiNg Multiple SclErosis previously treated with hiGhly-Active Disease modifying thErapies (RENEGADE study).Journal of neurology · 2025Observational
- Predictors of Radiological and Clinical Disease Reactivation in Multiple Sclerosis Patients After Cessation of Natalizumab (Tysabri).Brain and behavior · 2025Article
- De-escalating and discontinuing disease-modifying therapies in multiple sclerosis.Brain : a journal of neurology · 2025Review
- Should we stay or should we go? Recent insights on drug discontinuation in multiple sclerosis.Neurological research and practice · 2025Review
- Natalizumab Treatment Induces Proinflammatory CD4 T Cells Preferentially in the Integrin β7+ Compartment.Neurology(R) neuroimmunology & neuroinflammation · 2023Article
- Experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years.Scientific reports · 2021Article
- Rituximab in Multiple Sclerosis: Are We Ready for Regulatory Approval?Frontiers in immunology · 2021Review
- Cessation of anti-VLA-4 therapy in a focal rat model of multiple sclerosis causes an increase in neuroinflammation.EJNMMI research · 2019Article
- Post-natalizumab disease reactivation in multiple sclerosis: systematic review and meta-analysis.Therapeutic advances in neurological disorders · 2019Article
- Effectiveness and Safety of Dimethyl Fumarate Treatment in Relapsing Multiple Sclerosis Patients: Real-World Evidence.Neurology and therapy · 2017Article
- High-Risk PML Patients Switching from Natalizumab to Alemtuzumab: an Observational Study.Neurology and therapy · 2017Article
- Natalizumab in Multiple Sclerosis: Long-Term Management.International journal of molecular sciences · 2017Review
- Article
- Relapse frequency in transitioning from natalizumab to dimethyl fumarate: assessment of risk factors.Journal of neurology · 2016Article
- Real-world treatment outcomes and safety of natalizumab in Finnish multiple sclerosis patients.Multiple sclerosis journal - experimental, translational and clinicalArticle
- The Dilemma of When to Stop Disease-Modifying Therapy in Multiple Sclerosis: A Narrative Review and Canadian Regional Reimbursement Policies.International journal of MS careArticle
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionNatalizumab (NTZ) discontinuation can be followed by multiple sclerosis (MS) disease reactivation. Currently no disease-modifying drug (DMD) has been shown to be able to abolish disease reactivation. The aims of the current study were: (1) to determine the frequency of MS reactivation after NTZ discontinuation; (2) to evaluate predictors of reactivation risk, and (3) to compare the effect of different treatments in reducing this risk.
methodsData from 132 patients with MS followed-up for 2 years before NTZ treatment and 1 year after interruption were collected from two Italian MS centers and retrospectively evaluated.
resultsOverall, 72 of 132 patients (54.5%) had relapses after NTZ discontinuation and 60 of 125 patients (48%), who had magnetic resonance imaging, had radiological reactivation. Rebound was observed in 28 of 132 patients (21.2%). A higher number of relapses in the 2 years before NTZ treatment, a longer washout period, and a lower number NTZ infusions correlated with reactivation and rebound. Untreated patients (n = 37) had higher clinical and radiological activity and rebound in comparison to patients receiving DMDs. Moreover, a lower risk of relapses was found in patients treated with second-line therapies (NTZ and fingolimod) than in those treated with first-line therapies (interferon beta, glatiramer acetate, teriflunomide, azathioprine). Interestingly, no disease reactivation in off-label treatment (rituximab, autologous hematopoietic stem cell transplantation) was observed.
conclusionNTZ discontinuation is a risk for MS reactivation and rebound. An alternative treatment should be promptly resumed mainly in patients with a previous very active disease course and with a shorter NTZ therapy. Second-line therapies demonstrate superiority in preventing relapses after NTZ discontinuation.
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