Archives of neurology · 2012
Failure of natalizumab to prevent relapses in neuromyelitis optica.
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Kleiter Ingo, Hellwig Kerstin, Berthele Achim, Kümpfel Tania, Linker Ralf A, Hartung Hans-Peter, Paul Friedemann, Aktas Orhan, Neuromyelitis Optica Study Group
Аннотация
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.
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.