Switching therapy from natalizumab to fingolimod in relapsing-remitting MS: clinical and magnetic resonance imaging findings

This study from Italy looked at 22 people with relapsing-remitting MS with positive JC virus, who were switched from natalizumab to fingolimod after a three month washout period. A brain MRI was performed within one month after fingolimod initiation. Clinically a neurological examination with the EDSS was carried out monthly for a mean follow-up of nine months. Results from the study showed that in the first month after fingolimod initiation, disease reactivation was seen in seven patients. Of these, four patients had clinical lapses, while three patients had the appearance of new MRI lesions without clinical evidence. One patient experienced clinical reactivation after three months. One patient developed both clinical and radiological signs of disease after five months.

Overall, disease reactivation was observed in 50% (11/22) of fingolimod-treated patients. These results raises the question that fingolimod does not exert clinical activity fast enough to suppress MS reactivation following cessation of natalizumab, particularly in very active RRMS and those on natalizumab for more than two years.

Rinaldi F, Seppi D, Calabrese M

Mult Scler. 2012 Nov;18(11):1640-3. doi: 10.1177/1352458512464282.

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