Predictors for multiple sclerosis relapses after switching from natalizumab to fingolimod

Abstract

There was an increase of the ARR in the first year after switching from NAT to FTY. Last EDSS during the switching period was a predictor of relapses during FTY.

Natalizumab-withdrawal-in-multiple-sclerosis-RR-patients-what-to-expect

“…Based on this pharmacokinetic profile, NAT should be fully cleared from circulation approximately 2 months (5 half-lives) after the last dose13. According to this observation, we found that the mean time of the first relapse after NAT withdrawal was above 26 weeks, in line with the observations of Hoepner et al [14].…”

Natalizumab to Fingolimod Switching in Multiple Sclerosis: Results from a “Real Word” Retrospective Analysis

“…Disability and clinical course were also examined by Hoepner et collegues [11] in a smaller cohort of patients (n = 33) switching from natalizumab to fingolimod. The study found that 61% of patients relapsed after natalizumab discontinuation and 48% relapsed during fingolimod treatment (with a washout no longer than 24 weeks).…”

“…Fingolimod (Gilenya, Novartis, Basel, Switzerland) is an option for these patients [1,3,[8][9][10][11][12] however, because of the still unknown impact on the immune system of the concomitant presence of these molecules, an interval is recommended between discontinuing natalizumab and starting fingolimod. Studies investigating switching from natalizumab to fingolimod have shown clinically relevant disease activity during the first weeks of fingolimod treatment, challenging its effectiveness in this setting, and highlighting the need to clarify its role in patients with a disease characterized by its severity and rapid evolution, and to improve the switching protocol [9,11].…”

“…Although this topic has been largely discussed in literature [9,11,12], the current study aims in providing a descriptive analysis of a large cohort of patients followed for many years. Indeed, while previous research only considered patient's clinical course in the previous year, the objective of this study is to describe the patients' whole disease course and to analyse predictive factors for disease relapse.…”

Advances in and Algorithms for the Treatment of Relapsing-Remitting Multiple Sclerosis

“…The obvious candidate in this situation appears to be fingolimod which was recently shown to be advantageous over injectables after cessation of natalizumab [98], but is probably clinically less potent than natalizumab. Furthermore, some recent data strongly suggest that a switch from natalizumab to fingolimod may be associated with an increased risk of developing new disease activity [99,100]. A recent report came to the conclusion that too-long washout phases between natalizumab discontinuation and fingolimod initiation may elevate that risk and recommends waiting 4-8 weeks between treatments [101].…”