Severe relapses under fingolimod treatment prescribed after natalizumab

his research group from Italy looked at the rate of relapse following a change of treatment to fingolimod from natalizumab in 3 patients with relapsing-remitting MS. Fingolimod was started 3-4 months after natalizumab was stopped to help immune surveillance reconstitution and reduce the risk of postnatalizumab MS reactivation. The three patients developed severe MS reactivation 16 days, 19 days and 6 days after starting fingolimod.

These cases suggest that fingolimod is not effective in controlling rebound, when started 3-4 months after natalizumab cessation. More experience is needed to decide on the correct timing of switching patients from natalizumab to fingolimod.

Centonze D, Rossi S, Rinaldi F, Gallo P.

Neurology. 2012 Oct 3. [Epub ahead of print]

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