TY - JOUR
T1 - Failure of Natalizumab to Prevent Relapses in Neuromyelitis Optica
AU - Kleiter, Ingo
AU - Hellwig, Kerstin
AU - Berthele, Achim
AU - Kuempfel, Tania
AU - Linker, Ralf A.
AU - Hartung, Hans-Peter
AU - Paul, Friedemann
AU - Neuromyelitis Optica Study Grp
AU - Kleinschnitz, Christoph
AU - Aktas, Orhan
PY - 2012/2
Y1 - 2012/2
N2 - To describe first experiences with the integrin inhibitor natalizumab, given to patients with suspected relapsing-remitting multiple sclerosis (MS) who were later diagnosed with aquaporin 4-positive neuromyelitis optica (NMO).Retrospective case series.Neurology departments at tertiary referral centers in Germany.Patients with NMO who tested positive for antibodies to aquaporin 4.Treatment with natalizumab.Relapses and accumulation of disability.We identified 5 patients (4 female; median age, 45 years) who were initially diagnosed with MS and treated with natalizumab before diagnosis of NMO was established. Natalizumab was given as escalation therapy after failure of first- or second-line immunomodulatory therapies for MS. During natalizumab therapy (median duration, 8 infusions; range, 2-11 infusions), all 5 patients displayed persisting disease activity; a total of 9 relapses occurred (median duration to relapse, 120 days; range, 45-230 days) after the start of treatment. Four patients had an accumulation of disability and 1 patient died 2 months after cessation of natalizumab treatment.Our results suggest that natalizumab fails to control disease activity in patients with NMO. Neuromyelitis optica should be considered as a differential diagnosis in patients with suspected MS who are unresponsive to natalizumab therapy.
AB - To describe first experiences with the integrin inhibitor natalizumab, given to patients with suspected relapsing-remitting multiple sclerosis (MS) who were later diagnosed with aquaporin 4-positive neuromyelitis optica (NMO).Retrospective case series.Neurology departments at tertiary referral centers in Germany.Patients with NMO who tested positive for antibodies to aquaporin 4.Treatment with natalizumab.Relapses and accumulation of disability.We identified 5 patients (4 female; median age, 45 years) who were initially diagnosed with MS and treated with natalizumab before diagnosis of NMO was established. Natalizumab was given as escalation therapy after failure of first- or second-line immunomodulatory therapies for MS. During natalizumab therapy (median duration, 8 infusions; range, 2-11 infusions), all 5 patients displayed persisting disease activity; a total of 9 relapses occurred (median duration to relapse, 120 days; range, 45-230 days) after the start of treatment. Four patients had an accumulation of disability and 1 patient died 2 months after cessation of natalizumab treatment.Our results suggest that natalizumab fails to control disease activity in patients with NMO. Neuromyelitis optica should be considered as a differential diagnosis in patients with suspected MS who are unresponsive to natalizumab therapy.
U2 - 10.1001/archneurol.2011.216
DO - 10.1001/archneurol.2011.216
M3 - Article
C2 - 22332191
SN - 0003-9942
VL - 69
SP - 239
EP - 245
JO - Archives of Neurology
JF - Archives of Neurology
IS - 2
ER -