Failure of natalizumab to prevent relapses in neuromyelitis optica

Ingo Kleiter, Kerstin Hellwig, Achim Berthele, Tania Kümpfel, Ralf A. Linker, Hans Peter Hartung, Friedemann Paul, Orhan Aktas

Research output: Contribution to journalArticlepeer-review

253 Scopus citations

Abstract

Objective: To describe first experiences with the integrin inhibitor natalizumab, given to patients with suspected relapsing-remitting multiple sclerosis (MS) who were later diagnosed with aquaporin 4-positive neuromyelitis optica (NMO). Design: Retrospective case series. Setting: Neurology departments at tertiary referral centers in Germany. Patients: Patients withNMOwho tested positive for antibodies to aquaporin 4. Intervention: Treatment with natalizumab. Main Outcome Measures: Relapses and accumulation of disability. Results: We identified 5 patients (4 female; median age, 45 years) who were initially diagnosed withMSand treated with natalizumab before diagnosis of NMO was established. Natalizumab was given as escalation therapy after failure of first- or second-line immunomodulatory therapies for MS. During natalizumab therapy (median duration, 8 infusions; range, 2-11 infusions), all 5 patients displayed persisting disease activity; a total of 9 relapses occurred (median duration to relapse, 120 days; range, 45-230 days) after the start of treatment. Four patients had an accumulation of disability and 1 patient died 2 months after cessation of natalizumab treatment. Conclusions: Our results suggest that natalizumab fails to control disease activity in patients with NMO. Neuromyelitis optica should be considered as a differential diagnosis in patients with suspected MS who are unresponsive to natalizumab therapy.

Original languageEnglish
Pages (from-to)239-245
Number of pages7
JournalArchives of Neurology
Volume69
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

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