Real-World Lab Data in Natalizumab Treated Multiple Sclerosis Patients Up to 6 Years Long-Term Follow Up

Abstract

Natalizumab inhibits the transmigration of immune cells across the blood-brain barrier thus inhibiting inflammation in the central nervous system. Generally, this blockade at the blood-brain barrier has significant influence on the circulating lymphocytes. Up to date, only short-term data on peripheral blood parameters are available which are mostly from controlled clinical trials and not from real-world experience. Real-world lab data of 120 patients diagnosed with highly active disease course of relapsing-remitting multiple sclerosis (RRMS) were analyzed during natalizumab treatment. Patient sampling was performed by consecutive recruitment in the Multiple Sclerosis Center Dresden. Lab testing was performed before and at every third infusion up to 72 months follow-up. After first natalizumab infusion, absolute numbers of all major lymphocyte populations including CD4+ T-cells, CD8+ T-cells, CD19+ B-cells, and NK-cells significantly increased and remained stable during the whole observation period of 72 months. Upon lymphocyte subsets, CD19+ B-cells presented a disproportionate increase up to levels higher than normal level in most of the treated patients. Neutralizing antibodies to natalizumab abrogated the described changes. Intra-individual variation of lymphocytes and its subsets remained in a narrow range for the whole treatment period. CD4/CD8 ratio did not change compared to baseline measurement up to 6 years of natalizumab treatment. Monocytes, eosinophils, and basophils, but not neutrophils persistently increased during natalizumab treatment. Hematological parameters including erythrocyte, platelet count, hemoglobin, and hematocrit remained unchanged compared to baseline. Interestingly, immature precursor cells including erythroblasts were detectable in 36,8% of the treated patients during natalizumab therapy, but not in the pretreatment period. Asymptomatic elevations of liver enzymes were rare, mostly only transient and lower than 3x upper normal limit. Kidney function parameters remained stable within physiological ranges in most patients. CRP levels >20 mg/dl were recognized only in 10 patients during natalizumab therapy and were mostly linked to respiratory tract infections. In our present analysis, we report persistent, but stable increases of peripheral immune cell subtypes in natalizumab treated patients. Additional serological analyses confirm excellent tolerability and safety even 6 years after natalizumab initiation in post-marketing experience.

The TCR Repertoire Reconstitution in Multiple Sclerosis: Comparing One-Shot and Continuous Immunosuppressive Therapies

“…CD8+ naive repertoire diversity is commonly higher compared to memory (CM, EM, and TEMRA) CD8+ subpopulations (41), and it represents, along with crossreactivity, the major strategy adopted by the immune system to face a great variety of antigens (42). Natalizumab has been shown to reduce immune surveillance modulating immune cell populations and subpopulations (43)(44)(45). Therefore, the reduced TCR diversity of CD8+ naive cells in our NTZ repertoires may reflect decreased immune protection.…”

<p>Drug-use patterns and severe adverse events with disease-modifying drugs in patients with multiple sclerosis: a cohort study based on German claims data</p>

“…15,16 Data on drug-use patterns of DMDs in clinical practice and the incidence of serious adverse events from Germany is scarce. Available evidence is mostly restricted to studies of individual drugs [17][18][19][20][21][22][23] or is almost outdated and does not cover newer drugs, such as natalizumab or fingolimod. 24 Therefore, the objective of this study was to describe the clinical characteristics and drug-use patterns of MS patients using DMDs and to estimate the incidence of severe adverse events in DMD users.…”

Natalizumab in Multiple Sclerosis Treatment: From Biological Effects to Immune Monitoring

“…The net result is an important lymphocytosis following the first injection which soon reached a stable plateau. The more altered cells were B lymphocytes (more than 3 times pre-treatment values), NK and T lymphocytes (2 and 1.8, respectively) without modification of the CD4+/CD8+ ratio ( 36 – 38 ). Cell numbers decreased after 8 weeks of treatment interruption and returned to basal levels around 16 weeks after this interruption ( 38 ).…”