Abstract Details

Title Analysis of disease activity return after natalizumab withdrawal in multiple sclerosis

Topic Multiple Sclerosis

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-069

Objective

To assess the clinical disease activity following cessation of natalizumab therapy.

Background In multiple sclerosis (MS) natalizumab (NTZ) withdrawal may lead to a “rebound” of inflammatory activity defined as severe relapse and unusually high inflammatory MRI activity. In our MS center two different schedules with intravenously metilprednisolone (IVMP) were established to reduce the probability of rebound.

Design/Methods Retrospective analysis of patients treated with NTZ during more than 2 years that were discontinued between January 2012 and January 2017 for inefficacy or safety reasons. Patients received two schedules within NTZ-washout period (WP): Schedule 1 (years 2012-2013): 3 months WP. 1,2 and 3 IVMP grams, every month respectively. Schedule 2 (2014-2016): 2 months WP. 1 and 2 IVMP grams every month respectively. Ten days after every schedule, new disease modifying treatment (DMT) was initiated. Clinical and MRI evaluations (new/enlarged T2 and gadolinium enhancing lesions) were performed at 3rd, 6th, 12th and 24th months after NTZ-washout.

Results

Fifty patients discontinued NTZ in the analyzed period (68%women, mean age -years-37.76+/-10.88, mean EDSS 3.7+/-1.73). New DMT was fingolimod in 77.6%.
Annualized relapse rate (ARR) at 6th month was 0.32+/-0.84; MRI activity was observed in 25% of patients and “rebound” criteria only in 10% (n=5). ARR during WP was 0.1+/-0.7. No differences of clinical and MRI activity between both schedules was observed.

Rebound was found in younger patients and was associated with higher ARR
during the two years after NTZ and a higher presence of MRI activity
at 3rd and 12th months, with no differences in EDSS scores after two
years of follow-up. Neither pre-NTZ ARR nor new DMT was associated with
rebound.

Conclusions Both IVMP schedules during WP was well tolerated and rebound was observed in only 10% of cases. In our study, IVMP could have reduced the possibility of rebound since in other series the proportion is higher.

Authors/Disclosures
PRESENTER	No disclosure on file
Jose Maria Cabrera Maqueda	Mr. Cabrera Maqueda has nothing to disclose.
Ester Carreon Guarnizo	Ester Carreon Guarnizo has nothing to disclose.
Rocio Hernandez Clares, MD, PhD (Virgen De La Arrixaca Hospital)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Ana M. Morales Ortiz	No disclosure on file
Jose Meca Lallana, MD (Hospital Clinico Universitario Virgen De La Arrixaca)	Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol-Myers-Squibb. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Meca Lallana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. The institution of Dr. Meca Lallana has received research support from Merck. The institution of Dr. Meca Lallana has received research support from Novartis. The institution of Dr. Meca Lallana has received research support from Roche. The institution of Dr. Meca Lallana has received research support from Sanofi. The institution of Dr. Meca Lallana has received research support from Biogen.

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