Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(08): 650-652
DOI: 10.1590/0004-282X20160090
TRICKS OF THE TRADE

Safety of switching from natalizumab straight into fingolimod in a group of JCV-positive patients with multiple sclerosis

Segurança na mudança direta de natalizumabe para fingolimode em um grupo de pacientes com esclerose múltipla e positivos para JCV
Yara Dadalti Fragoso
1   Universidade Metropolitana de Santos, Departamento de Neurologia, Santos SP, Brasil;
,
Soniza Vieira Alves-Leon
2   Universidade Federal do Estado do Rio de Janeiro, Departamento de Neurologia, Rio de Janeiro RJ, Brasil;
,
Jefferson Becker
3   Pontifícia Universidade Católica do Rio Grande do Sul, Departamento de Neurologia, Porto Alegre RS, Brasil;
,
Joseph Bruno Bidin Brooks
1   Universidade Metropolitana de Santos, Departamento de Neurologia, Santos SP, Brasil;
,
Eber Castro Correa
4   Clinica de Neurologia e Endocrinologia (CLINEN), Departamento de Neurologia, Brasília DF, Brasil;
,
Alfredo Damasceno
5   Universidade Estadual de Campinas, Departamento de Neurologia, Campinas SP, Brasil;
,
Paulo Diniz da Gama
6   Pontifícia Universidade Católica Sorocaba, Departamento de Neurologia, Sorocaba SP, Brasil;
,
Rodrigo Assad da Gama
6   Pontifícia Universidade Católica Sorocaba, Departamento de Neurologia, Sorocaba SP, Brasil;
,
Andre Palma da Cunha Matta
7   Universidade Federal Fluminense, Departamento de Neurologia, Niterói RJ, Brasil;
,
Ernane Pires Maciel
8   Hospital de Base do Distrito Federal, Departamento de Neurologia, Brasília DF, Brasil;
,
Thereza Cristina d’Avila Winckler
9   Universidade Positivo, Departamento de Neurologia, Curitiba PR, Brasil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Objective To assess safety of the switch between natalizumab and fingolimod without a washout period.

Methods Prospective data on 25 JCV positive patients who underwent this medication switch were collected and analyzed.

Results After a median period of nine months from the medication switch, there were no safety issues to report. The patients had good disease control and no adverse events were reported.

Conclusion Washout may not be necessary in daily practice when switching from natalizumab to fingolimod. Expertise on multiple sclerosis management, however, is essential for drug switching.

RESUMO

Objetivo Avaliar a segurança na mudança entre natalizumabe e fingolimode sem período de washout.

Métodos Dados prospectivos de 25 pacientes positivos para vírus JC que tiveram sua medicação modificada foram coletados e analisados.

Resultados Após uma mediana de nove meses da troca de medicação, não havia aspectos de segurança a relatar. Os pacientes estavam com bom controle da doença e não foram relatados eventos adversos.

Conclusão Washout pode não ser necessário na prática diária para a mudança entre natalizumabe e fingolimode. No entanto, expertise no manejo de esclerose múltipla é essencial para esta troca entre medicações.

multiple sclerosis - natalizumab - fingolimod hydrochloride - therapeutics
esclerose múltipla - natalizumab - cloridrato de fingolimode - terapêutica


Publication History

Received: 13 January 2016

Accepted: 24 May 2016

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Derfuss T, Kuhle J, Lindberg R, Kappos L. Natalizumab therapy for multiple sclerosis. Semin Neurol. 2013;33(1):26-36. doi:10.1055/s-0033-1343793
  • 2 Tur C, Montalban X. Natalizumab: risk stratification of individual patients with multiple sclerosis. CNS Drugs. 2014;28(7):641-8. doi:10.1007/s40263-014-0168-0
  • 3 Baumgartner A, Stich O, Rauer S. Clinical and radiological disease reactivation after cessation of long-term therapy with natalizumab. Int J Neurosci. 2012;122(1):35-9. doi:10.3109/00207454.2011.622452
  • 4 Capobianco M, di Sapio A, Malentacchi M, Malucchi S, Matta M, Sperli F et al. No impact of current therapeutic strategies on disease reactivation after natalizumab discontinuation: a comparative analysis of different approaches during the first year of natalizumab discontinuation. Eur J Neurol. 2015;22(3):585-7. doi:10.1111/ene.12487
  • 5 Stüve O, Cravens PD, Frohman EM, Phillips JT, Remington GM, Geldern G et al. Immunologic, clinical, and radiologic status 14 months after cessation of natalizumab therapy. Neurology. 2009;72(5):396-401. doi:10.1212/01.wnl.0000327341.89587.76
  • 6 Rispens T, Vennegoor A, Wolbink GJ, Polman CH, Killestein J. Natalizumab remains detectable in patients with multiple sclerosis long after treatment is stopped. Mult Scler. 2012;18(6):899-901. doi:10.1177/1352458511431073
  • 7 Kappos L, Radue EW, Comi G, Montalban X, Butzkueven H, Wiendl H et al. Switching from natalizumab to fingolimod: A randomized, placebo-controlled study in RRMS. Neurology. 2015;85(1):29-39. doi:10.1212/WNL.20160090201600901706
  • 8 Iaffaldano P, Lucisano G, Pozzilli C, Brescia Morra V, Ghezzi A, Millefiorini E et al. Fingolimod versus interferon beta/glatiramer acetate after natalizumab suspension in multiple sclerosis. Brain. 2015;138(11)3275-86. doi:10.1093/brain/awv260
  • 9 Fragoso YD, Adoni T, Alves-Leon S, Apostolo-Pereira SL, Araujo YR, Becker J et al. Alternatives for reducing relapse rate when switching from natalizumab to fingolimod in multiple sclerosis. Exp Rev Clin Pharmacol. 2016;9(4). doi:10.1586/17512433.2016.1145053
  • 10 Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33(11):1444-52. doi:10.1212/WNL.33.11.1444