ArticleBrain and behavior2025
Predictors of Radiological and Clinical Disease Reactivation in Multiple Sclerosis Patients After Cessation of Natalizumab (Tysabri).
Article in Brain and behavior, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
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3 authors.
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Abstract
background and purposeNatalizumab (NTZ) is widely used for patients with highly active relapsing-remitting multiple sclerosis (RRMS), but its discontinuation can lead to disease reactivation, significantly impacting Middle Eastern populations. This study aimed to assess the frequency of disease reactivation post-NTZ discontinuation and identify possible demographic predictors.
methodsIn this retrospective single-center study, 171 patients with RRMS who received at least six consecutive NTZ infusions were analyzed. Clinical and radiological data were sourced from the AMIR registry. Binary and multivariate regression analyses were performed to identify factors associated with reactivation risk after 1 year, with a subset undergoing brain magnetic resonance imaging (MRI) segmentation and volumetric assessments.
resultsAmong 92 eligible patients, 16 (17%) showed disease reactivation. Prolonged washout periods (>3 months) significantly increased reactivation risk (hazard ratio [HR] 1.015, 95% CI 1.007-1.022, p < 0.001), whereas higher Expanded Disability Status Scale (EDSS) scores correlated with a reduced risk (HR 0.492, 95% CI 0.280-0.866, p < 0.014). In the subset of cases that underwent brain MRI segmentation, higher NTZ infusion numbers and delayed bridging therapy initiation were linked to increased reactivation risk.
conclusionNTZ discontinuation requires thorough clinical evaluation for bridging therapy, yet optimal strategies remain undefined. Early bridging therapy initiation may mitigate reactivation, highlighting the need for further research on predictive factors and disease-modifying therapy efficacy.
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