ClinicSpeak: natalizumab has a positive effect on attention and depression

How bad is your brain fog? #ClinicSpeak #MSResearch #MSBlog

"I always finding amazing when an MSer with highly-active MS come back to see me in clinic after 6 months of being on natalizumab and states 'I feel normal, my brain fog has lifted and my fatigue has gone'. Why? I suspect one component of cognitive fatigue and the so called brain fog is due to inflammation in the brain. Once MSers start on a highly-effective DMT that switches the inflammation off they notice the difference. We know that the mediators of inflammation affect how the brain functions. MSers describe feeling like they have never ending flu; this is how they describe the fog. The study below formally demonstrates some of the observations; with improvements in attention and depression after starting natalizumab. It is a pity the drug is not 'safe' to use in everyone. Because of the PML risk it is deemed too risky to use long-term in ~50% of MSers, who are positive for JCV. In the other half of MSers it is relatively safe; despite this the European regulators and payers won't allow us to use it first-line with the exception in the UK being MSers with rapidly-evolving severe MS (two disabling attacks in a 12 month period with MRI evidence of active disease). I wonder if and when these treatment guidelines will change?"

Brain fog!

Kunkel et al. Impact of natalizumab treatment on fatigue, mood, and aspects of cognition in relapsing-remittingmultiple sclerosis. Front Neurol. 2015 May 11;6:97. doi: 10.3389/fneur.2015.00097. eCollection 2015

BACKGROUND/OBJECTIVE: Fatigue, cognitive, and affective disorders are relevant symptoms in multiple sclerosis (MS). The treatment with Natalizumab has a positive effect on physical disabilities in patients with relapsing-remitting MS (RRMS). Some studies describe improvements in cognition and fatigue over 1 year of treatment. Only little is known about longer treatment effects especially on fatigue, and also on cognition and mood. Therefore, the present retrospective open label observational study investigates the effect of Natalizumab on fatigue, attention, and depression over a treatment period of 2 years.

METHODS: About 51 RRMSers who were treated with Natalizumab (male = 11, female = 40; mean age: 33. 9 ± 9. 1 years) were included. The neuropsychological assessment consisted of different tests of attention (TAP: alertness, divided attention, flexibility, SDMT, PASAT), fatigue (WEIMuS, FSMC), and depression (CES-D). The assessments occurred immediately before the first administration of Natalizumab, after 1 and 2 years of treatment.

RESULTS: Significant improvements were found in aspects of attention and depression from baseline to follow-up 1 [alertness: reaction time (RT) cued, p < 0.05; divided attention: visual RT, p < 0.05; SDMT: p = 0.05; CES-D: p < 0.05] and from baseline to follow-up 2 (divided attention: visual RT: p < 0.001; errors: p < 0.01, omissions: p < 0.05; flexibility: RT, p < 0.05; SDMT: p < 0.01; CES-D: p < 0.05). No significant changes were detected in fatigue, probably because of the small sample size, especially in the second year of treatment (WEIMuS: N = 16, FSMC: N = 8).

CONCLUSION: The results show a positive effect of Natalizumab on attention in MSers with RRMS, and for the first time, also in depression after 2 years of observation, and support the efficacy of the treatment over 2 years. More research is needed for fatigue.

CoI: multiple

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