“This study confirms what we already know that IFN-beta and GA are not good enough, on average, to prevent rebound on weaning natalizumab. What is interesting is that MSers switched from natalizumab to GA combined with pulsed monthly steroids did worse than those switched to GA alone. This may indicate that steroids interfere with the mode of action of GA. In summary when switching from natalizumab to other DMTs you need to go onto a higher efficacy DMT to prevent rebound. The data is strongest for fingolimod. The data also supports no wash-out, i.e starting fingolimod within 4 weeks of the last natalizumab infusion. This allows the fingolimod to be active prior to natalizumab dropping to sub-therapeutic levels.”
BACKGROUND: Natalizumab (NTZ) discontinuation leads to MS recurrence, but represents the only known strategy to limit the risk of progressive multifocal leukoencephalopathy (PML) in JCV seropositive MSers. Here, we compared the clinical and imaging features of three groups of MSers who discontinued NTZ treatment.
METHODS: We treated 25 MSers with subcutaneous INFβ-1b (INF group), 40 MSers with glatiramer acetate (GA group), and 40 MSers with GA plus pulse steroid (GA+CS group).
RESULTS: Six of 25 MSers (24%) of the INF group were relapse-free 6 months after NTZ suspension. In GA group, a significant higher proportion of patients (26 of 40 patients, 65%) were relapse-free (P < 0.05). Far from improving the clinical effects of GA in post-NTZ setting, combination of GA+CS was associated with lower relapse-free rate than GA alone (40% vs. 65%, P = 0.04). Also on MRI parameters, combination of GA+CS was associated with worse outcome than GA alone, as 22 of 26 subjects (84.6%) had MRI evidence of disease activity 6 months after NTZ discontinuation.
CONCLUSION: Corticosteroids should not be used in combination with GA to prevent post-NTZ disease recurrence.