Epub: Rossi et al. Treatment Options to Reduce Disease Activity After Natalizumab: Paradoxical Effects of Corticosteroids. CNS Neurosci Ther. 2014 May. doi: 10.1111/cns.12282.
BACKGROUND: Natalizumab (NTZ) discontinuation leads to MS recurrence, but represents the only known strategy to limit the risk of progressive multifocal leukoencephalopathy (PML) in JCV seropositive MSers. Here, we compared the clinical and imaging features of three groups of MSers who discontinued NTZ treatment.
METHODS: We treated 25 MSers with subcutaneous INFβ-1b (INF group), 40 MSers with glatiramer acetate (GA group), and 40 MSers with GA plus pulse steroid (GA+CS group).
RESULTS: Six of 25 MSers (24%) of the INF group were relapse-free 6 months after NTZ suspension. In GA group, a significant higher proportion of patients (26 of 40 patients, 65%) were relapse-free (P < 0.05). Far from improving the clinical effects of GA in post-NTZ setting, combination of GA+CS was associated with lower relapse-free rate than GA alone (40% vs. 65%, P = 0.04). Also on MRI parameters, combination of GA+CS was associated with worse outcome than GA alone, as 22 of 26 subjects (84.6%) had MRI evidence of disease activity 6 months after NTZ discontinuation.
CONCLUSION: Corticosteroids should not be used in combination with GA to prevent post-NTZ disease recurrence.
CoI: multiple