2017
DOI: 10.1002/brb3.671
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Catastrophic outcome of patients with a rebound after Natalizumab treatment discontinuation

Abstract: IntroductionNatalizumab (NTZ) is an effective drug for the treatment of relapsing‐remitting multiple sclerosis. In some patients discontinuation is mandatory due to the risk of progressive multifocal leukoencephalopathy. However, severe clinical and radiological worsening has been described after drug cessation. Our aim was to describe the clinical and radiological features of the rebound phenomenon.Material and MethodsPatients switched from NTZ to Fingolimod (FTY) who had presented a rebound after discontinua… Show more

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Cited by 35 publications
(24 citation statements)
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“…Although NTZ+ patients showed an increased ARR in the first year of treatment with FNG, two thirds of them were relapse-free after 2 years, more than half of them maintain NEDA-3 status in the first year and 42% in the second year of treatment. These results are in line with the previous observations [6,11,13,18,[24][25][26]. Furthermore, we confirmed that previous NTZ treatment, just as younger age, and ≥ 1 relapse in the pre-treatment year are significantly associated with an increased risk of relapsing under FNG treatment, as previously demonstrated [8].…”
Section: Sustained Disability Progressionsupporting
confidence: 93%
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“…Although NTZ+ patients showed an increased ARR in the first year of treatment with FNG, two thirds of them were relapse-free after 2 years, more than half of them maintain NEDA-3 status in the first year and 42% in the second year of treatment. These results are in line with the previous observations [6,11,13,18,[24][25][26]. Furthermore, we confirmed that previous NTZ treatment, just as younger age, and ≥ 1 relapse in the pre-treatment year are significantly associated with an increased risk of relapsing under FNG treatment, as previously demonstrated [8].…”
Section: Sustained Disability Progressionsupporting
confidence: 93%
“…The effectiveness results obtained in our study are in line with the efficacy data shown in the 0.5-mg/day FNG arm of the 12- [4,13,23,24]. Regarding the NEDA-3 status, our study showed that 67.9% and 54.6% of RRMS patients was NEDA-3 after the first year and the second year of treatment.…”
Section: Sustained Disability Progressionsupporting
confidence: 90%
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“…It might take >10 weeks to attain the beneficial effect of DMF after initiation; hence, careful attention is required for relapses after the cessation of previous drugs . Disease activities might be exacerbated after the cessation of some DMD . Essentially, avoid the washout period as much as possible, although careful monitoring for lymphocyte count and MRI activities is warranted.…”
Section: Four Questions and Answers For Dmf In The 2017 Supplement Ofmentioning
confidence: 99%
“…The return of disease (the "rebound" phenomenon) probably refl ects an increased permeability of the blood-brain barrier with the consequent massive transfer of activated lymphocytes from peripheral blood to CNS. The rebound rate varies among studies between 10 % and 30 % of patients and occurs frequently within the 3-6 months after NTZ withdrawal (15).…”
mentioning
confidence: 99%