Natalizumab (
Nat) is a humanized
monoclonal antibody used for the treatment of relapsing
multiple sclerosis (MS).
Nat inhibits lymphocyte migration via the blood brain barrier (BBB) by blockage of an
integrin adhesion molecule,
very late antigen 4. During the phase III clinical trials, it was shown that
Nat reduces disease activity and prevents disability progression. In addition, several smaller studies indicate a positive influence of
Nat on cognition, depression,
fatigue, and quality of life (Qol). Therapeutic efficacy has to be weighed against the risk of developing potentially fatal
progressive multifocal leukoencephalopathy (PML), an
opportunistic infection by JC-virus (JCV) with an incidence of 3.4/1000 (95% CI 3.08-3.74) in
Nat treated MS patients. In this review article, we will review data on the presumed mechanism of
Nat action, clinical and paraclinical efficacy parameters, and
adverse drug reactions with a special focus on PML.