To describe patients who switched from anti-CD20 therapy to natalizumab in the treatment of multiple sclerosis (MS)

Three patients were included in this study. Patients at anti-CD20 initiation were ages 65, 32, and 50; had a disease duration from diagnosis of 32, 17, and 5 years; and were all female. One patient was secondary progressive MS, and 2 were relapsing-remitting MS. All patients were on natalizumab prior for 48, 58, and 135 months and received their last dose within one month of anti-CD20 initiation. Two patients initiated rituximab, and one patient initiated ocrelizumab. Reasons for switching to anti-CD20 therapy were receiving a JCV positive test, for ease of planning pregnancy, and patient preference due to the feeling of progressing. Both rituximab patients received only one dose of 1000mg. The patient on ocrelizumab received a split total dose of 600mg, 14 days apart. Reasons for switching back to natalizumab for all patients were overall feeling worse since switching to anti-CD20 and resurgence of old symptoms. Time from the anti-CD20 infusion to restarting natalizumab (washout period) were 4.1, 5.9, and 4.1 months. JC virus titers at time of switch from anti-CD20 to natalizumab were 0.24, 0.13, and 0.12.