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Best practice recommendations for the selection and management of patients with multiple sclerosis receiving natalizumab therapyDepartment of Neurology, Stony Brook University Medical Center and Stony Brook MS Comprehensive Care Center, Stony Brook, NY, USA
Rocky Mountain MS Clinic, Rocky Mountain Neurological Associates, Salt Lake City, UT, USA
MS Clinic of Central Texas and University of Texas Medical Branch, Central Texas Neurology Consultants, Round Rock, TX, USA
Department of Neurology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
Department of Neurology, The Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, USA, fmunschauer{at}kaleidahealth.org
Department of Neurology, Multiple Sclerosis Center, Georgetown University Medical Center, Washington, DC, USA
Natalizumab, a humanized monoclonal antibody directed against
Key Words: multiple sclerosis • treatment • drug therapy • natalizumab • progressive multifocal leukoencephalopathy
Multiple Sclerosis, Vol. 15, No. 4 Suppl,
S26-S36 (2009) |
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4-integrin is a first-in-class disease-modifying therapy for the treatment of relapsing multiple sclerosis. Natalizumab is highly effective but has been associated with a risk of progressive multifocal leukoencephalopathy. Since the efficacy of natalizumab in relapsing forms of multiple sclerosis is viewed as superior to first-line agents, a growing number of neurologists are using natalizumab as the treatment of choice for patients with worsening MS. Owing to the recently reported cases of progressive multifocal leukoencephalopathy, a panel of neurologists met in February 2009 to discuss best practices for the use of natalizumab, with the goal of developing consensus-based recommendations on patient management to minimize the risk of progressive multifocal leukoencephalopathy. The panel consisted of a cross section of academic and community neurologists from the United States who treat multiple sclerosis in large centers and have extensive experience with natalizumab (approximating 2000 patient-years combined experience). This paper summarizes the panel’s recommendations on the following: (1) appropriate patient selection for natalizumab; (2) routine monitoring and management of adverse events during natalizumab therapy; and (3) clinical vigilance monitoring and risk reduction for progressive multifocal leukoencephalopathy.