Published: April 12, 2010
Reviewed by Ari Green, MD; Assistant Professor, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
In reviewing the latest reports on treatment with natalizumab, John Corboy, MD, professor of neurology at the University of Colorado School of Medicine in Denver, noted that one small study from researchers in Texas (Stuve, et al Neurology 2009; 72: 396-401) showed few ill effects as a result of stopping natalizumab.
"They seem to be just fine," Corboy said, "but all these patients were put on interferon or other things."
However, he noted that researchers in Boston observed that if patients are not put on interferon regimens, a significant number on a so-called drug holiday began to show MRI lesions and started having relapses after about 60 to 90 days.
"So if you are going to take someone off natalizumab, you probably should have a plan to substitute something else in order to avoid so-called immune reconstitution inflammatory syndrome and relapses," Corboy said in his presentation at the annual meeting of the American Academy of Neurology here.
The main reason for discontinuing natalizumab, he said, is concern about development of life-threatening progressive multifocal leukoencephalopathy (PML). A lingering concern remains that putting patients on an alternative therapy may not mitigate the risk of PML and allow for recovery of immune surveillance.
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