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Arch Neurol. 2012 Feb;69(2):239-45. doi: 10.1001/archneurol.2011.216.

Failure of natalizumab to prevent relapses in neuromyelitis optica.

Author information

1
Department of Neurology, University Medical Center Regensburg, Regensburg, Germany. ingo.kleiter@rub.de

Abstract

OBJECTIVE:

To describe first experiences with the integrin inhibitor natalizumab, given to patients with suspected relapsing-remitting multiple sclerosis (MS) who were later diagnosed with aquaporin 4-positive neuromyelitis optica (NMO).

DESIGN:

Retrospective case series.

SETTING:

Neurology departments at tertiary referral centers in Germany.

PATIENTS:

Patients with NMO who tested positive for antibodies to aquaporin 4.

INTERVENTION:

Treatment with natalizumab.

MAIN OUTCOME MEASURES:

Relapses and accumulation of disability.

RESULTS:

We identified 5 patients (4 female; median age, 45 years) who were initially diagnosed with MS and treated with natalizumab before diagnosis of NMO was established. Natalizumab was given as escalation therapy after failure of first- or second-line immunomodulatory therapies for MS. During natalizumab therapy (median duration, 8 infusions; range, 2-11 infusions), all 5 patients displayed persisting disease activity; a total of 9 relapses occurred (median duration to relapse, 120 days; range, 45-230 days) after the start of treatment. Four patients had an accumulation of disability and 1 patient died 2 months after cessation of natalizumab treatment.

CONCLUSIONS:

Our results suggest that natalizumab fails to control disease activity in patients with NMO. Neuromyelitis optica should be considered as a differential diagnosis in patients with suspected MS who are unresponsive to natalizumab therapy.

PMID:
22332191
DOI:
10.1001/archneurol.2011.216
[Indexed for MEDLINE]
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