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Gelissen LMY, Loveless S, Toorop AA, Howlett J, Loeff FC, Rispens T, Killestein J, Tallantyre EC, van Kempen ZLE. Subcutaneous administration of natalizumab can lead to lower drug concentrations compared to intravenous administration. Mult Scler Relat Disord 2024; 90:105796. [PMID: 39096666 DOI: 10.1016/j.msard.2024.105796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/19/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Several studies reported lower drug concentrations with subcutaneous natalizumab compared to intravenous natalizumab. With the emergence of extended interval dosing, gaining more insight into lower concentrations after subcutaneous administration is essential. METHODS We compared serum trough concentrations between subcutaneous and intravenous administration within a matched cohort (n = 50). RESULTS Subcutaneous administration (n = 25) was associated with lower concentrations compared to intravenous administration (n = 25) (log-B=-0.28, p = 0.01). In an exploratory group of 11 patients receiving extended interval dosing of subcutaneous natalizumab, the median trough concentration was even lower. CONCLUSION Subcutaneous natalizumab can lead to lower drug concentrations, potentially limiting extended interval dosing.
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Affiliation(s)
- Liza M Y Gelissen
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology Outpatient Clinic, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands.
| | - Sam Loveless
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Alyssa A Toorop
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology Outpatient Clinic, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands
| | - Jayne Howlett
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Floris C Loeff
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Theo Rispens
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, the Netherlands; Department of Immunopathology, Sanquin Research & Landsteiner Laboratory Academic Medical Centre, Amsterdam, Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology Outpatient Clinic, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands
| | - Emma C Tallantyre
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK; Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Zoé L E van Kempen
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology Outpatient Clinic, De Boelelaan 1118, Amsterdam 1081 HV, the Netherlands
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Gross RH, Corboy J. De-escalation and Discontinuation of Disease-Modifying Therapies in Multiple Sclerosis. Curr Neurol Neurosci Rep 2024; 24:341-353. [PMID: 38995483 DOI: 10.1007/s11910-024-01355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE OF REVIEW Long-term use of multiple sclerosis (MS) disease-modifying therapies (DMTs) is standard practice to prevent accumulation of disability. Immunosenescence and other age-related changes lead to an altered risk-benefit ratio for older patients on DMTs. This article reviews recent research on the topic of de-escalation and discontinuation of MS DMTs. RECENT FINDINGS Observational and interventional studies have shed light on what happens to patients who de-escalate or discontinue DMTs and the factors, such as age, treatment type, and presence of recent disease activity, that influence outcomes. Though many questions remain, recent findings have been valuable for the development of an evidence-based approach to making de-escalation and discontinuation decisions in MS.
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Affiliation(s)
- Robert H Gross
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17thAvenue, Mail Stop F727, Aurora, CO, 80045, USA.
- Department of Neurology, Rocky Mountain Regional Veterans Administration Medical Center, Aurora, CO, USA.
| | - John Corboy
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17thAvenue, Mail Stop F727, Aurora, CO, 80045, USA
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Koch M. Prospective trial of natalizumab personalised extended interval dosing by therapeutic drug monitoring in relapsing-remitting multiple sclerosis (NEXT-MS). J Neurol Neurosurg Psychiatry 2024; 95:391. [PMID: 37963724 DOI: 10.1136/jnnp-2023-332758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Marcus Koch
- Clinical Neurosciences, University of Calgary, Calgary, AB T2N 1N4, Canada
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Toljan K, Conway DS. Extended interval dosing of natalizumab: More evidence in support. Neurotherapeutics 2024; 21:e00351. [PMID: 38531713 PMCID: PMC11070702 DOI: 10.1016/j.neurot.2024.e00351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 03/17/2024] [Indexed: 03/28/2024] Open
Affiliation(s)
- Karlo Toljan
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue / U10, Cleveland, OH, 44195, USA
| | - Devon S Conway
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue / U10, Cleveland, OH, 44195, USA.
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Toorop AA, Noteboom S, Steenwijk MD, Gravendeel JW, Jasperse B, Barkhof F, Strijbis EMM, Rispens T, Schoonheim MM, van Kempen ZLE, Killestein J. Exploring the effects of extended interval dosing of natalizumab and drug concentrations on brain atrophy in multiple sclerosis. Mult Scler 2024; 30:266-271. [PMID: 38235514 PMCID: PMC10851624 DOI: 10.1177/13524585231225855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/01/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Extended interval dosing (EID) of natalizumab treatment is increasingly used in multiple sclerosis. Besides the clear anti-inflammatory effect, natalizumab is considered to have neuroprotective properties as well. OBJECTIVES This study aimed to study the longitudinal effects of EID compared to standard interval dosing (SID) and natalizumab drug concentrations on brain atrophy. METHODS Patients receiving EID or SID of natalizumab with a minimum radiological follow-up of 2 years were included. Changes in brain atrophy measures over time were derived from clinical routine 3D-Fluid Attenuated Inversion Recovery (FLAIR)-weighted magnetic resonance imaging (MRI) scans using SynthSeg. RESULTS We found no differences between EID (n = 32) and SID (n = 50) for whole brain (-0.21% vs -0.16%, p = 0.42), ventricular (1.84% vs 1.13%, p = 0.24), and thalamic (-0.32% vs -0.32%, p = 0.97) annualized volume change over a median follow-up of 3.2 years. No associations between natalizumab drug concentration and brain atrophy rate were found. CONCLUSION We found no clear evidence that EID compared to SID or lower natalizumab drug concentrations have a negative impact on the development of brain atrophy over time.
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Affiliation(s)
- Alyssa A Toorop
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Samantha Noteboom
- MS Center Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Martijn D Steenwijk
- MS Center Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Job W Gravendeel
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bas Jasperse
- MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frederik Barkhof
- MS Center Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Eva MM Strijbis
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Biologics Laboratory and Department of Immunopathology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- MS Center Amsterdam, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Zoé LE van Kempen
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joep Killestein
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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