Failure of natalizumab to prevent relapses in neuromyelitis optica.

Abstract

OBJECTIVE:

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).

DESIGN:

Retrospective case series.

SETTING:

Neurology departments at tertiary referral centers in Germany.

PATIENTS:

Patients with NMO who tested positive for antibodies to aquaporin 4.

INTERVENTION:

Treatment with natalizumab.

MAIN OUTCOME MEASURES:

Relapses and accumulation of disability.

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: Ingo Kleiter, Kerstin Hellwig, Achim Berthele, Tania Kümpfel, Ralf A Linker, Hans-Peter Hartung, Friedemann Paul, Orhan Aktas, Neuromyelitis Optica Study Group
• Journal: Archives of neurology (Arch Neurol) Vol. 69 Issue 2 Pg. 239-45 (Feb 2012) ISSN: 1538-3687 [Electronic] United States
• PMID: 22332191 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal, Humanized
• Aquaporin 4
• Autoantibodies
• Natalizumab

Topics

• Adult
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Aquaporin 4 (blood, immunology)
• Autoantibodies (analysis)
• Disability Evaluation
• Female
• Humans
• Male
• Middle Aged
• Multiple Sclerosis, Relapsing-Remitting (complications, drug therapy)
• Natalizumab
• Neuromyelitis Optica (prevention & control)
• Secondary Prevention
• Treatment Failure
• Treatment Outcome