Pulsed steroids followed by glatiramer acetate to prevent inflammatory activity after cessation of natalizumab therapy: a prospective, 6-month observational study |
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Authors: | María José Magraner Francisco Coret Arantxa Navarré Isabel Boscá María Simó Matilde Escutia Ana Bernad Laura Navarro Bonaventura Casanova |
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Institution: | 1.Multiple Sclerosis Unit,Hospital Universitari I Politècnic La Fe, Valencia,Valencia,Spain;2.Multiple Sclerosis Unit,Hospital Clínico Valencia,Valencia,Spain |
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Abstract: | In this study, the tolerability and safety of treatment with pulsed steroids and glatiramer acetate and the occurrence of
clinical and radiological activity after natalizumab (NTZ) cessation in multiple sclerosis (MS) patients were assessed. MS
patients with NTZ were discontinued after 2 years of treatment, or if adverse events or disease progressed during NTZ. They
were offered as alternative treatment 1 g methylprednisolone per month during 3 months followed by daily 20 mcg glatiramer
acetate and were prospectively studied. Adverse events, occurrence of immune reconstitution inflammatory syndrome, clinical
exacerbations, and gadolinium-enhancing lesions in MRI performed at 3 and 6 months after NTZ cessation were recorded. EDSS
change during follow-up was also recorded. A total of 18 MS patients entered the study and were followed up for a mean of
10 months (range 6–18 months). There were no significant adverse events. At month 3, no patient had clinical or radiological
disease activity. At month 6, 16.6% of patients had had a relapse and 55.5% of patients showed gadolinium-enhancing lesions
in the MRI. After 6 months, 33.3% of patients had a further relapse. There was no IRIS, severe relapses, or significant difference
between EDSS at NTZ discontinuation and after follow-up. The alternative treatment with monthly prednisolone followed by GA
prevents the development of IRIS, but not the return to previous inflammatory activity, which occurs between 5 and 6 months
after NTZ withdrawal. |
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