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Expert Rev Clin Pharmacol. 2016 Feb 21:1-6. [Epub ahead of print]

Alternatives for reducing relapse rate when switching from natalizumab to fingolimod in multiple sclerosis.

Author information

1
a Department of Neurology , Universidade Metropolitana de Santos , Santos , Brazil.
2
b Department of Neurology , Hospital Sirio Libanes , Sao Paulo , Brazil.
3
c Department of Neurology , Universidade Federal do Estado do Rio de Janeiro , Rio de Janeiro , Brazil.
4
d Department of Neurology , Hospital das Clinicas da Universidade de Sao Paulo , Sao Paulo , Brazil.
5
e Department of Neurology , Hospital de Base do Distrito Federal , Brasilia , Brazil.
6
f Department of Neurology , Pontificia Universidade Catolica do Rio Grande do Sul , Porto Alegre , Brazil.
7
g Department of Neurology , CLINEN , Brasilia , Brazil.
8
h Department of Neurology , Universidade Estadual de Campinas , Campinas , Brazil.
9
i Department of Neurology , Universidade Federal de Juiz de Fora , Juiz de Fora , Brazil.
10
j Department of Neurology , Hospital da Restauracao , Recife , Brazil.
11
k Department of Neurology , Pontificia Universidade Catolica Sorocaba , Sorocaba , Brazil.
12
l Department of Neurology , Hospital Beneficencia Portuguesa de Sao Paulo , São Paulo , Brazil.
13
m Department of Neurology , Regional Hans Dieter Schimidt, Centro Hospitalar Unimed , Joinville , Brazil.
14
n Department of Neurology , CRIDAC , Cuiaba , Brazil.
15
o Department of Neurology , Hospital de Caridade , Florianopolis , Brazil.
16
p Department of Neurology , Universidade Federal Fluminense , Niteroi , Brazil.
17
q Department of Neurology , Irmandade da Santa Casa de Misericordia de Sao Paulo , Sao Paulo , Brazil.
18
r Department of Neurology , Universidade Federal de Goias , Goiania , Brazil.
19
s Department of Neurology , Neurological Clinic Belo Horizonte , Belo Horizonte , Brazil.
20
t Department of Neurology , Universidade de Jundiai , Jundiai , Brazil.
21
u Department of Neurology , Neurological Institute Curitiba , Curitiba , Brazil.
22
v Department of Neurology , Universidade Federal do Espirito Santo , Vitoria , Brazil.

Abstract

Natalizumab is a therapeutic option for treating multiple sclerosis (MS) and is particularly efficacious for patients with highly active disease. A long washout period has been recommended between withdrawal of natalizumab and start of fingolimod (another option for treating MS). This long washout period has been associated with a significant increase in MS activity. In the present study, a group of 96 patients who were switched from natalizumab to fingolimod had short washout periods between drugs, or monthly corticosteroid pulse therapy if longer washout periods were recommended. This therapeutic approach led to the lowest reported relapse rate so far, among patients with MS switching from natalizumab to fingolimod (8.3%). No complications from short withdrawal were observed in this group of patients.

KEYWORDS:

Natalizumab; fingolimod; multiple sclerosis; progressive multifocal leukoencephalopathy

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