Alternatives for reducing relapse rate when switching from natalizumab to fingolimod in multiple sclerosis

ABSTRACT

Natalizumab is a therapeutic option for treating multiple sclerosis (MS) and is particularly efficacious for patients with highly active disease. A long washout period has been recommended between withdrawal of natalizumab and start of fingolimod (another option for treating MS). This long washout period has been associated with a significant increase in MS activity. In the present study, a group of 96 patients who were switched from natalizumab to fingolimod had short washout periods between drugs, or monthly corticosteroid pulse therapy if longer washout periods were recommended. This therapeutic approach led to the lowest reported relapse rate so far, among patients with MS switching from natalizumab to fingolimod (8.3%). No complications from short withdrawal were observed in this group of patients.

KEYWORDS:

• Natalizumab
• fingolimod
• progressive multifocal leukoencephalopathy
• multiple sclerosis

Acknowledgments

The authors acknowledge the invaluable help of other neurologists and the nurses in the MS units, as well as the cardiologists involved in administration of the first dose of FTY.

Financial and competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.