Efficacy of Natalizumab in multiple sclerosis patients with high disease activity: Casablanca neurology department's experience

Abstract

Natalizumab (NTZ) as a high-cost long-term disease-modifying treatment indicated as a basic mono-therapy in patients with active relapsing-remitting multiple sclerosis (RRMS) has provided clinical efficiency. We evaluated clinical and radiological features and outcome of our NTZ MS patients. All RRMS patients defined by the 2010 McDonald criteria who received Natalizumab (NTZ) treatment any time since 2013. Variables analysed included age, gender, disease duration, MRI, Expanded Disability Status Scale (EDSS), previous treatment, relapse rate before and after receiving NTZ, adverse events, complications, and reasons of discontinuation. Of 16 patients in our study, the female-to-male ratio was 2:1. The mean age was 33 years, mean disease duration was 12 years with a range of (2-25). At the time of this analysis, 14 patients had received 1 year of NTZ. Approximately 80% of these patients were relapse-free after 1 year. The relapse rate after treatment was significantly lower (0,13 Vs 4,5). Fifteen patients haveN9 T2 lesions at the beginning of treatment with only 7 patients that had Gd-enhancing lesions on MRI, 87% had achieved radiological NEDA (No evidence disease activity). We didn't notice any opportunistic infections such as progressive multifocal leukoencephalopathy (PML), or any adverse events. However, treatment was discontinued in 2 cases because of pregnancy in 1 patient and high positive JC virus serology with a high risk of PML in the other. NTZ significantly reduces progression of disability, occurrence of clinical relapse and formation of new lesions at MRI in our MS patients. However, PML increasing risk require a longer-term follow-up.