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

• Published in: Lancet neurology 2011-08, Vol.10 (8), p.745-758
• Main Authors: Kappos, Ludwig, Prof, Bates, David, Prof, Edan, Gilles, Prof, Eraksoy, Mefkûre, MD, Garcia-Merino, Antonio, MD, Grigoriadis, Nikolaos, MD, Hartung, Hans-Peter, Prof, Havrdová, Eva, MD, Hillert, Jan, MD, Hohlfeld, Reinhard, Prof, Kremenchutzky, Marcelo, MD, Lyon-Caen, Olivier, Prof, Miller, Ariel, MD, Pozzilli, Carlo, Prof, Ravnborg, Mads, MD, Saida, Takahiko, MD, Sindic, Christian, Prof, Vass, Karl, MD, Clifford, David B, Prof, Hauser, Stephen, Prof, Major, Eugene O, PhD, O'Connor, Paul W, Prof, Weiner, Howard L, Prof, Clanet, Michel, Prof, Gold, Ralf, Prof, Hirsch, Hans H, Prof, Radü, Ernst-Wilhelm, Prof, Sørensen, Per Soelberg, Prof, King, John, MD
• Format: Article
• Language: English
• Subjects: Animals; Antibodies; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Clinical medicine; Drug dosages; Drug Monitoring - methods; Drug Monitoring - standards; Humans; Integrin alpha4beta1 - antagonists & inhibitors; Leukoencephalopathy, Progressive Multifocal - chemically induced; Leukoencephalopathy, Progressive Multifocal - diagnosis; Marketing; Medical research; Medicin och hälsovetenskap; Multiple sclerosis; Multiple Sclerosis, Relapsing-Remitting - drug therapy; Natalizumab; Neurology; Patient Selection; Patients; Practice Guidelines as Topic - standards; Progressive multifocal leukoencephalopathy; Reviews; Treatment Outcome
• ISSN: 1474-4422; 1474-4465; 1474-4465
• DOI: 10.1016/S1474-4422(11)70149-1

Summary Natalizumab, a highly specific α4-integrin antagonist, is approved for treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). It is generally recommended for individuals who have not responded to a currently available first-line disease-modifying therapy or who have very active disease. The expected benefits of natalizumab treatment have to be weighed against risks, especially the rare but serious adverse event of progressive multifocal leukoencephalopathy. In this Review, we revisit and update previous recommendations on natalizumab for treatment of patients with RRMS, based on additional long-term follow-up of clinical studies and post-marketing observations, including appropriate patient selection and management recommendations.