Use of natalizumab in persons with multiple sclerosis: 2022 update

•Real-world long-term studies substantiate the benefit of early treatment using natalizumab in patients with RRMS.•Extended interval dosing (Q6W) of natalizumab has comparable effectiveness to Q4W and mitigates the risk of PML.•Treatment discontinuation and switching from natalizumab are important c...

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Published in:Multiple sclerosis and related disorders 2022-09, Vol.65, p.103995-103995, Article 103995
Main Authors: Morrow, Sarah A., Clift, Fraser, Devonshire, Virginia, Lapointe, Emmanuelle, Schneider, Raphael, Stefanelli, Mark, Vosoughi, Reza
Format: Article
Language:English
Subjects:
Clinical practice
Disease-modifying therapy
Multiple sclerosis
Natalizumab
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Summary:•Real-world long-term studies substantiate the benefit of early treatment using natalizumab in patients with RRMS.•Extended interval dosing (Q6W) of natalizumab has comparable effectiveness to Q4W and mitigates the risk of PML.•Treatment discontinuation and switching from natalizumab are important clinical management considerations for physicians. Natalizumab is a humanized monoclonal antibody used for treatment of highly active relapsing-remitting multiple sclerosis (MS). With more than 15 years of post-marketing experience with natalizumab in Canada, several real-world studies have shown the long-term efficacy and safety of natalizumab. In addition, risk stratification/mitigation strategies for progressive leukoencephalopathy (PML), an adverse effect associated with natalizumab based on the John Cunningham virus (JCV) index; treatment duration beyond 24 months; and prior exposure to immunosuppressant drugs have been developed. A group of neurologists from various MS clinics across Canada met in September 2021 to update the 2015 Canadian practice recommendations for the use of natalizumab in persons with MS (PwMS). The recommendations focused on the long-term efficacy and safety data from real-world studies, patient selection according to JCV index criteria, risk management strategies for PML (including extended interval dosing), and options for switching to currently available disease-modifying therapies for MS. The recommendations of clinical neurologists seek to optimize the management of PwMS who may benefit from treatment with natalizumab.
ISSN:2211-0348
2211-0356
DOI:10.1016/j.msard.2022.103995