Epub: Rigau et al. LETHAL MULTIPLE SCLEROSIS RELAPSE AFTER NATALIZUMAB WITHDRAWAL. Neurology. 2012 Oct 24.
Natalizumab dramatically reduces relapses in MSers with active MS, but it may induce progressive multifocal leukoencephalopathy (PML).(1) A rebound of MS or an immune reconstitution inflammatory syndrome (IRIS) were described after natalizumab withdrawal, even in the absence of PML. Very few data concerning the potential severity and the neuropathology of this event are available. These investigators' report a case of a 50-year-old MSer who developed a fulminating relapse 3 months after stopping natalizumab, leading to death despite intensive care and immunosuppressive therapy. Radiologic and neuropathologic findings provide interesting data regarding the nature of the rebound.
"Rumour has it that there are quite a few cases with fulminant / pseudotumoural cases of MS that have occurred after switching from natalizumab to fingolimod. What is this telling us about MS? Could there be a virus hidden behind a sealed blood brain barrier that is exposed to the immune system after withdrawal of Natalizumab? These observation support the viral hypothesis of MS. This also has major implications of how we manage natalizumab-fingolimod switchers."
Recent post of interest:
30 Oct 2012
Disease reactivation was observed in 11/22 (50%) MSers: clinical relapses in six MSers (four MSers within the first month of therapy) and MRI activity in a further five MSers (three MSers within the first month of therapy).
Labels: fingolimod, fulminant MS, Natalizumab