caa a22 4500 445807830 CHVBK 20180317145202.0 cr unu---uuuuu 170323e20110901xx s 000 0 eng 10.1007/s00415-011-5996-y doi (NATIONALLICENCE)springer-10.1007/s00415-011-5996-y De-escalation from natalizumab in multiple sclerosis: recurrence of disease activity despite switching to glatiramer acetate [Elektronische Daten] [Joachim Havla, Lisa Gerdes, Ingrid Meinl, Markus Krumbholz, Hans Faber, Frank Weber, Hannah Pellkofer, Reinhard Hohlfeld, Tania Kümpfel] Natalizumab (NAT) is an effective therapy for relapsing-remitting multiple sclerosis (MS), but is associated with an increased risk of progressive multifocal leucoencephalopathy after 2years therapy. Thus, NAT treated patients often decide to stop NAT therapy after 2years. Reports on recurrence of disease activity after NAT discontinuation are controversial. We studied disease activity in 13 MS patients who stopped NAT therapy and either remained without disease modifying therapy (no DMT, n=6), or switched to glatiramer acetate (GLAT, n=7). Annual relapse rate (ARR), expanded disability status scale (EDSS), and number of patients with contrast-enhancing-lesions (Gd+) on MRI before, during and within 1year after NAT were determined. We observed recurrence of disease activity in both groups (5/7 GLAT treated patients and 6/6 patients without DMT) within 12months after cessation of NAT (mean time to first relapse was 5.5months for all patients). One of the GLAT treated patients and three patients without DMT had severe relapses with sustained EDSS worsening. No differences in ARR, EDSS and MRI parameters were seen between both groups. Patients with relapses after NAT therapy, however, tended to show higher disease activity (EDSS, ARR) before initiation of NAT therapy compared to patients without relapses. Duration of NAT treatment was not associated with higher disease activity after NAT discontinuation. In this observation the majority of patients showed reappearance of disease activity after discontinuation of NAT regardless of whether they switched to GLAT or remained without DMT. Further treatment strategies are warranted for patients who discontinue NAT therapy. Springer-Verlag, 2011 Multiple sclerosis nationallicence Natalizumab nationallicence De-escalation nationallicence Glatiramer acetate nationallicence Havla Joachim Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut Gerdes Lisa Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut Meinl Ingrid Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut Krumbholz Markus Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut Faber Hans Max Planck Institute of Psychiatry, Section of Neurology, Kraepelinstr. 2-10, 80804, Munich, Germany aut Weber Frank Max Planck Institute of Psychiatry, Section of Neurology, Kraepelinstr. 2-10, 80804, Munich, Germany aut Pellkofer Hannah Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut Hohlfeld Reinhard Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut Kümpfel Tania Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut Journal of Neurology Springer-Verlag 258/9(2011-09-01), 1665-1669 0340-5354 258:9<1665 2011 258 415 https://doi.org/10.1007/s00415-011-5996-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00415-011-5996-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Havla Joachim Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Gerdes Lisa Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Meinl Ingrid Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Krumbholz Markus Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Faber Hans Max Planck Institute of Psychiatry, Section of Neurology, Kraepelinstr. 2-10, 80804, Munich, Germany aut NATIONALLICENCE 700 1- Weber Frank Max Planck Institute of Psychiatry, Section of Neurology, Kraepelinstr. 2-10, 80804, Munich, Germany aut NATIONALLICENCE 700 1- Pellkofer Hannah Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Hohlfeld Reinhard Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut NATIONALLICENCE 700 1- Kümpfel Tania Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany aut NATIONALLICENCE 773 0- Journal of Neurology Springer-Verlag 258/9(2011-09-01), 1665-1669 0340-5354 258:9<1665 2011 258 415 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer