Zivadinov R, Hojnacki D, Bergsland N, Kennedy C, Hagemeier J, Melia R, Ramasamy DP, Durfee J, Carl E, Dwyer MG, Weinstock-Guttman B. Effect of natalizumab on brain atrophy and disability progression in multiple sclerosis patients over 5 years.Eur J Neurol. 2016. doi: 10.1111/ene.12992. [Epub ahead of print]
BACKGROUND AND PURPOSE: The long-term benefit of natalizumab on brain atrophy progression in multiple sclerosis (MS) patients is unknown. Our aim was to investigate its effect over 5 years.
METHODS: This prospective study included 60 relapsing MS patients who started natalizumab treatment in years 2006-2007.
RESULTS: At the 5-year follow-up, 20 patients discontinued natalizumab after an average of 29.5 cycles, 27 continued natalizumab treatment with some periods of honeymoon (average of 38.4 infusions) and 13 never stopped natalizumab (average of 60.6 infusions). The number of natalizumab infusions was associated with decrease of relapse rate (P = 0.037), but no association was found with the progression of disability, accumulation of lesion burden or brain volume loss. However, only one (8%) patient in the continuous monthly group experienced disability progression compared to 10 (37%) in the non-continuous and seven (35%) in the discontinuation natalizumab groups. At the follow-up, two patients had died [one from a fatal case of progressive multifocal leukoencephalopathy (PML) and one from a car accident] and 15 patients were lost to follow-up. There was another case of non-fatal PML over the follow-up.
CONCLUSIONS: In line with previous reports, MS patients with longer and continuous use of natalizumab had fewer relapses and remained stable in their disability status. No difference in lesion burden accumulation or brain atrophy development was found in relation to the duration of natalizumab use. PML occurred in 2.5% of patients in this small sample cohort. Given the increased risk of PML and uncertain benefit of prolonged natalizumab use on clinical and MRI outcomes of disease progression found in this study, a careful risk-benefit therapeutic assessment is mandatory.
This is a thing you all want to know, which is what are the long term consequences of the different treatments and notably what is the prognosis, will getting relapses in check stop your disease. I hope so, but does the data really support this. It is often hard to tell, especially in the age of softly, softly where we don’t do antthing until things are going wrong and then we get the big guns out, rather comming out blasting right from the get go. in the adsence of real advice based on follow-up of large number of people, centred report on small studies based on their experiences.
Natalizumab is believed to be one of the more effective DMT when it comes to stopping relapses but what happens with longt-term use.
There was bad news for 3% as they got PML, which is twice the Biogen rate, but closer to others predicted and as 33% of this cohort stopped natalizumab after about 2-3 years this means that PML risk was actually higher. However in the 20% of users would took the PML risk and stayed on drug and took it as prescribed then 12/13 (92%) did not progress clinically compared to 65% who discontinued but they could not find an assossication of treatment and disability however if you start with a small sample and loose track of 20% of the population it is going to be difficult to get this information. Surely the pharma companies could give us this information based on the thousands of people treated with natalizumab. So more good reason to sign up to an MS registry so some one other than pharma can have large numbers and do these types of follow-ups that may not give us the answer that pharma would like to hear .
So if you live in the UK why not sign up to the MS register