Abstract Details

Title Fingolimod Initiation at the Time of Return of Clinical Activity Following Natalizumab Cessation: Short Term Outcome

Topic MS and Related Diseases

Presentation(s) P01 - (-)

Poster/Presentation
Number 208

Objective

Background BACKGROUND: The risk of progressive multifocal leukoencephalopathy (PML) associated with prolonged natalizumab (NTZ) use in JCV-seropositive patients may lead clinicians to prompt this treatment. Return of clinical activity after NTZ withdrawal might motivate to switch with fingolimod but the short term efficacy of this strategy is not clear.

Design/Methods DESIGN/METHODS: Detailed biological, clinical and MRI data of four patients.

Results RESULTS: Four JCV-seropositives RRMS patients interrupted NTZ because PML risk after 20 to 40 infusions. All patients experienced severe relapse after NTZ cessation (range 3 to 6 months). Fingolimod was initiated after a washout period ranging from 3 to15. All patients experienced new severe relapses (increase in EDSS ranging from 1 to2.5 and high number of gadolinium enhancing lesions (ranging from 10 to 50) in the month following fingolimod initiation (time between initiation and relapse ranging from 10 to5 days). Total lymphocyte count at the time of relapse was low (ranging from 210 to 800/mm3.

Conclusions CONCLUSIONS: In our observations, fingolimod failed to control post NTZ cessation rebound of clinical activity despite drug induced lymphopenia. Regarding pharmokinetics data, earlier introduction of fingolimod (<3 months after NTZ interruption) may be more appropriate to control post natalizumab withdrawal relapses, but might be associated with maintenance of PML risk.

Authors/Disclosures
PRESENTER	No disclosure on file
Antoine Gueguen, MD (Fondation Oph. A. De Rothschild, Service De Neurologie)	An immediate family member of Dr. Gueguen has received personal compensation for serving as an employee of ABBVIE. Dr. Gueguen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for ALEXION. Dr. Gueguen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Jonhson&Jonhson. Dr. Gueguen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Johnson&Johnson. The institution of Dr. Gueguen has received research support from BrainEver. The institution of Dr. Gueguen has received research support from Pixyl. The institution of Dr. Gueguen has received research support from Kalsiom. The institution of Dr. Gueguen has received research support from Ministére de la Santé, France.
	No disclosure on file
	No disclosure on file
Caroline Bensa	Caroline Bensa has nothing to disclose.
Olivier F. Gout, MD (Hôpital Fondation A de Rothschild)	Dr. Gout has nothing to disclose.
Gareth R. John (Mount Sinai School of Medicine)	No disclosure on file

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