1
|
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] [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.
Collapse
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
| |
Collapse
|
2
|
Deffner M, Schneider-Hohendorf T, Schulte-Mecklenbeck A, Falk S, Lu IN, Ostkamp P, Müller-Miny L, Schumann EM, Goelz S, Cahir-McFarland E, Thakur KT, De Jager PL, Klotz L, Meyer Zu Hörste G, Gross CC, Wiendl H, Grauer OM, Schwab N. Chemokine-mediated cell migration into the central nervous system in progressive multifocal leukoencephalopathy. Cell Rep Med 2024; 5:101622. [PMID: 38917802 PMCID: PMC11293326 DOI: 10.1016/j.xcrm.2024.101622] [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: 02/21/2024] [Revised: 04/10/2024] [Accepted: 06/02/2024] [Indexed: 06/27/2024]
Abstract
Progressive multifocal leukoencephalopathy (PML) has been associated with different forms of immune compromise. This study analyzes the chemokine signals and attracted immune cells in cerebrospinal fluid (CSF) during PML to define immune cell subpopulations relevant for the PML immune response. In addition to chemokines that indicate a general state of inflammation, like CCL5 and CXCL10, the CSF of PML patients specifically contains CCL2 and CCL4. Single-cell transcriptomics of CSF cells suggests an enrichment of distinct CD4+ and CD8+ T cells expressing chemokine receptors CCR2, CCR5, and CXCR3, in addition to ITGA4 and the genetic PML risk genes STXBP2 and LY9. This suggests that specific immune cell subpopulations migrate into the central nervous system to mitigate PML, and their absence might coincide with PML development. Monitoring them might hold clues for PML risk, and boosting their recruitment or function before therapeutic immune reconstitution might improve its risk-benefit ratio.
Collapse
Affiliation(s)
- Marie Deffner
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Tilman Schneider-Hohendorf
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Simon Falk
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - I-Na Lu
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Patrick Ostkamp
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Louisa Müller-Miny
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Eva Maria Schumann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Susan Goelz
- Oregon Health & Science University, Portland, OR, USA; Biogen, Cambridge, MA, USA
| | | | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Philip L De Jager
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Gerd Meyer Zu Hörste
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Catharina C Gross
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Oliver M Grauer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Nicholas Schwab
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.
| |
Collapse
|
3
|
Toorop AA, van Lierop ZY, Gelissen LM, Hoitsma E, Zeinstra EM, van Rooij LC, van Munster CE, Vennegoor A, Mostert JP, Wokke BH, Kalkers NF, Hoogervorst EL, van Eijk JJ, Roosendaal CM, Kragt JJ, Eurelings M, van Genugten J, Nielsen J, Sinnige L, Kloosterziel ME, Arnoldus EP, van Dijk GW, Bouvy WH, Wessels MH, Boonkamp L, Strijbis EM, van Oosten BW, De Jong BA, Lissenberg-Witte BI, Barkhof F, Moraal B, Teunissen CE, Rispens T, Uitdehaag BM, Killestein J, van Kempen ZLE. Prospective trial of natalizumab personalised extended interval dosing by therapeutic drug monitoring in relapsing-remitting multiple sclerosis (NEXT-MS). J Neurol Neurosurg Psychiatry 2024; 95:392-400. [PMID: 37963723 DOI: 10.1136/jnnp-2023-332119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Extended interval dosing (EID) of natalizumab is a promising strategy to optimise treatment in multiple sclerosis (MS). Personalised EID by therapeutic drug monitoring can enable further extension of treatment intervals. METHODS The NEXT-MS trial is an investigator-initiated prospective phase IV non-randomised study. Adults with a diagnosis of relapsing-remitting MS who received ≥6 natalizumab infusions were included in three groups: personalised EID with a target drug trough concentration of 10 µg/mL (EID10), an exploratory group of personalised EID with a target of 5 µg/mL (EID5) and standard interval dosing (SID) of 4 weeks. The primary outcome is radiological disease activity (new/newly enlarged T2 lesions) comparing the EID10 group to a historical cohort of SID (HSID). RESULTS Results of the first phase of the NEXT-MS trial are reported here (n=376) as the study will continue with an amended protocol. In the EID10 group (n=251), incidence rate of radiological activity was 10.0 per 1000 person-years, which was non-inferior to the HSID cohort (24.7 per 1000 person-years (n=87), incidence rate difference 14.7, 90% CI -4.5 to 34.0). Incidence rate of radiological activity was 10.0 per 1000 person-years in the EID5 group (n=65), and 47.0 per 1000 person-years in the SID group (n=60). Serum neurofilament light levels did not increase over time within the EID groups. There were no cases of progressive multifocal leukoencephalopathy. CONCLUSIONS MS disease activity is adequately controlled with personalised natalizumab EID. Interval extension to a drug trough concentration of 5 µg/mL is likely a safe target to extend natalizumab treatment intervals >6 weeks. TRIAL REGISTRATION NUMBER NCT04225312.
Collapse
Affiliation(s)
- Alyssa A Toorop
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Zoë Ygj van Lierop
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Liza My Gelissen
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Elske Hoitsma
- Department of Neurology, MS Center, Alrijne Hospital, Leiden, The Netherlands
| | | | - Luuk C van Rooij
- Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Anke Vennegoor
- Department of Neurology, Flevoziekenhuis, Almere, The Netherlands
| | - Jop P Mostert
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Beatrijs Ha Wokke
- Department of Neurology, ErasMS, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nynke F Kalkers
- Department of Neurology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Jeroen Jj van Eijk
- Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Jolijn J Kragt
- Department of Neurology, Reinier de Graaf Hospital, Delft, The Netherlands
| | | | | | - Jessica Nielsen
- Department of Neurology, Ommelander Hospital Groningen, Scheemda, The Netherlands
| | - Lgf Sinnige
- Department of Neurology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Edo Pj Arnoldus
- Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - Gert W van Dijk
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Willem H Bouvy
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Mark Hj Wessels
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Lynn Boonkamp
- Neurochemistry Laboratory, Department of Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Eva Mm Strijbis
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Bob W van Oosten
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Brigit A De Jong
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Queen Square MS Centre, Department of Neuroinflammation, Faculty of Brain Sciences, University College London Hospitals and National Institute for Health Research, London, UK
| | - Bastiaan Moraal
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Theo Rispens
- Diagnostic Services and Immunopathology, Sanquin Research, Amsterdam, The Netherlands
- Department of Immunopathology, Landsteiner Laboratory, University of Amsterdam, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Joep Killestein
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Zoé LE van Kempen
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Rabea EM, Belal MM, Hafez AH, Elbanna AH, Khalifa MA, Nourelden AZ, Mahmoud NH, Zaazouee MS. Safety and efficacy of extended versus standard interval dosing of natalizumab in multiple sclerosis patients: a systematic review and meta-analysis. Acta Neurol Belg 2024; 124:407-417. [PMID: 38457005 PMCID: PMC10965735 DOI: 10.1007/s13760-024-02480-6] [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: 09/19/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory, immune-mediated disease affecting the central nervous system. Natalizumab, an FDA-approved monoclonal antibody for MS, has been explored for its off-label extended interval dosing (EID), suggesting a potential reduction in the risk of progressive multifocal leukoencephalopathy (PML) compared to standard interval dosing (SID). Our objective was to assess the efficacy and safety of EID in comparison to SID for natalizumab treatment in patients with MS. METHODS We searched PubMed, Embase, WOS, Scopus, Ovid, Science Direct, Clinical trials.gov, and Cochrane Library. Our assessed outcomes were clinical relapses, MRI activity, change in expanded disability status scale [EDSS], and the risk of PML. The EID group was defined as 5 to 8 weeks [EID (Q5-8W)]. The analysis was conducted using RevMan ver. 5.4. The effect estimates were presented as a risk ratio [RR] or mean difference with 95% confidence intervals [CI] using SID group as the reference for comparisons. RESULTS Fourteen studies met our inclusion criteria: 2 RCTs, 1 switched single-arm trial, and 12 observational studies. No significant differences were found in all efficacy outcomes of interest. Risk of clinical relapses [RR = 0.90, (95%CI 0.80, 1.02)], risk of new or newly enlarging T2 hyperintense MRI lesions [RR = 0.78, (95%CI 0.59, 1.04)], risk gadolinium enhancing lesions [RR = 1.30, (95%CI 0.98, 1.72)], change in EDSS [MD = 0.09 (95%CI - 0.57, 0.76)], risk of PML [RR = 1.09, 95%CI (0.24, 4.94)]. CONCLUSION In summary, our meta-analysis indicates that natalizumab maintains its effectiveness under extended interval dosing [up to 8 weeks], presenting comparable risks for clinical relapses, MRI lesions, EDSS, and PML. Caution is advised given study limitations and heterogeneity. Robust conclusions necessitate well-designed high-quality prospective studies.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Nada H Mahmoud
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | |
Collapse
|
5
|
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.
| |
Collapse
|
6
|
Matlak P, Brozmanova H, Sistik P, Kacirova I, Hradilek P, Grundmann M. Liquid chromatography - tandem mass spectrometry method for determination of natalizumab in serum and cerebrospinal fluid of patients with multiple sclerosis. J Pharm Biomed Anal 2023; 234:115542. [PMID: 37364452 DOI: 10.1016/j.jpba.2023.115542] [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: 02/16/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Natalizumab is a humanized recombinant monoclonal IgG4 antibody used in the treatment of multiple sclerosis. Commonly used methods for natalizumab and anti-natalizumab antibodies quantification are enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay, respectively. Measurement of therapeutic monoclonal antibodies can be challenging due to the resemblance to human plasma immunoglobulins. Recent developments in mass spectrometry enables to analyze vast variety of large protein molecules. The aim of this study was to develop a LC-MS/MS method for determining natalizumab in human serum and cerebrospinal fluid (CSF) and apply it to clinical settings. For successful quantification, it was necessary to find specific sequences of peptides in natalizumab. This immunoglobulin was treated with dithiothreitol and iodoacetamide, cleaved with trypsin into short specific peptides and determined on a UPLC-MS/MS system. An Acquity UPLC BEH C18 column at 55 °C and gradient elution was used for analysis. Intra- and interassay accuracies and precisions were tested at four concentration levels. Precision was determined by coefficients of variation and was in the range of 0.8-10.2 %, with accuracy in the range of 89.8-106.4 %. The concentration of natalizumab in patient samples ranged from 1.8 to 193.3 μg/mL. The method was validated according to the European Medicines Agency (EMA) guideline, met all acceptance criteria for accuracy and precision, and is suitable for clinical applications. In comparison to immunoassay, which can be elevated by cross-reaction with endogenous immunoglobulins, the results of developed LC-MS/MS method are more accurate and specific.
Collapse
Affiliation(s)
- Patrik Matlak
- Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic; Department of Clinical Pharmacology, Institute of Laboratory Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Hana Brozmanova
- Department of Clinical Pharmacology, Institute of Laboratory Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Pavel Sistik
- Department of Clinical Pharmacology, Institute of Laboratory Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.
| | - Ivana Kacirova
- Department of Clinical Pharmacology, Institute of Laboratory Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Pavel Hradilek
- Clinic of Neurology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; Clinic of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Milan Grundmann
- Department of Clinical Pharmacology, Institute of Laboratory Medicine, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Department of Clinical Pharmacology, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| |
Collapse
|
7
|
Soldati S, Bär A, Vladymyrov M, Glavin D, McGrath JL, Gosselet F, Nishihara H, Goelz S, Engelhardt B. High levels of endothelial ICAM-1 prohibit natalizumab mediated abrogation of CD4 + T cell arrest on the inflamed BBB under flow in vitro. J Neuroinflammation 2023; 20:123. [PMID: 37221552 DOI: 10.1186/s12974-023-02797-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/02/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION The humanized anti-α4 integrin blocking antibody natalizumab (NTZ) is an effective treatment for relapsing-remitting multiple sclerosis (RRMS) that is associated with the risk of progressive multifocal leukoencephalopathy (PML). While extended interval dosing (EID) of NTZ reduces the risk for PML, the minimal dose of NTZ required to maintain its therapeutic efficacy remains unknown. OBJECTIVE Here we aimed to identify the minimal NTZ concentration required to inhibit the arrest of human effector/memory CD4+ T cell subsets or of PBMCs to the blood-brain barrier (BBB) under physiological flow in vitro. RESULTS Making use of three different human in vitro BBB models and in vitro live-cell imaging we observed that NTZ mediated inhibition of α4-integrins failed to abrogate T cell arrest to the inflamed BBB under physiological flow. Complete inhibition of shear resistant T cell arrest required additional inhibition of β2-integrins, which correlated with a strong upregulation of endothelial intercellular adhesion molecule (ICAM)-1 on the respective BBB models investigated. Indeed, NTZ mediated inhibition of shear resistant T cell arrest to combinations of immobilized recombinant vascular cell adhesion molecule (VCAM)-1 and ICAM-1 was abrogated in the presence of tenfold higher molar concentrations of ICAM-1 over VCAM-1. Also, monovalent NTZ was less potent than bivalent NTZ in inhibiting T cell arrest to VCAM-1 under physiological flow. In accordance with our previous observations ICAM-1 but not VCAM-1 mediated T cell crawling against the direction of flow. CONCLUSION Taken together, our in vitro observations show that high levels of endothelial ICAM-1 abrogate NTZ mediated inhibition of T cell interaction with the BBB. EID of NTZ in MS patients may thus require consideration of the inflammatory status of the BBB as high levels of ICAM-1 may provide an alternative molecular cue allowing for pathogenic T cell entry into the CNS in the presence of NTZ.
Collapse
Affiliation(s)
- Sasha Soldati
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland
| | - Alexander Bär
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland
| | - Mykhailo Vladymyrov
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland
| | - Dale Glavin
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - James L McGrath
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Fabien Gosselet
- Blood-Brain Barrier Laboratory, University of Artois, Lens, France
| | - Hideaki Nishihara
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland
- Department of Neurotherapeutics, Yamaguchi University, Yamaguchi, Japan
| | | | - Britta Engelhardt
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland.
| |
Collapse
|
8
|
Jeantin L, Boudot de la Motte M, Deschamps R, Gueguen A, Gout O, Lecler A, Papeix C, Bensa C. Natalizumab extended-interval dosing in a real-life setting. J Neurol Sci 2023; 450:120689. [PMID: 37210938 DOI: 10.1016/j.jns.2023.120689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Natalizumab is a high-efficacy therapy for recurrent multiple sclerosis (RMS) with a four-week administration interval. Controlled trials have shown that extending this interval to six weeks led to better safety without increasing the risk of relapse. We aimed to analyze the safety of extending the natalizumab interdose interval from 4 to 6 weeks in a real-life setting. METHODS This monocentric retrospective self-controlled study included adult patients with RMS treated with natalizumab with a four-week interval between infusions for a minimum of six months, before switching to a six-week interval. The main outcomes were the incidence of MS relapse, new MRI lesions, and MRI activity signs during the two periods, with patients being their own controls. RESULTS Fifty-seven patients were included in the analysis. The mean (95%CI) annualized relapse rate (AAR) before natalizumab introduction was 1.03 (0.52; 1.55). During the four-week interval dosing period, no patient presented with an MS relapse, and seven (13.5%) patients had new MRI lesions. During the six-week interval dosing period, no relapse was observed and two (3.6%) patients had new MRI lesions. CONCLUSION We did not observe more relapses or signs of MRI activity when extending the interval between natalizumab infusions from four to six weeks.
Collapse
Affiliation(s)
- Lina Jeantin
- Neurology department, Hopital Fondation Adolphe de Rothschild, 25-29 rue Manin, Paris, France
| | | | - Romain Deschamps
- Neurology department, Hopital Fondation Adolphe de Rothschild, 25-29 rue Manin, Paris, France
| | - Antoine Gueguen
- Neurology department, Hopital Fondation Adolphe de Rothschild, 25-29 rue Manin, Paris, France
| | - Olivier Gout
- Neurology department, Hopital Fondation Adolphe de Rothschild, 25-29 rue Manin, Paris, France
| | - Augustin Lecler
- Neuroradiology department, Hopital Fondation Adolphe de Rothschild, 25-29 rue Manin, Paris, France
| | - Caroline Papeix
- Neurology department, Hopital Fondation Adolphe de Rothschild, 25-29 rue Manin, Paris, France
| | - Caroline Bensa
- Neurology department, Hopital Fondation Adolphe de Rothschild, 25-29 rue Manin, Paris, France.
| |
Collapse
|
9
|
Pelle J, Briant AR, Branger P, Derache N, Arnaud C, Lebrun-Frenay C, Cohen M, Mondot L, De Seze J, Bigaut K, Collongues N, Kremer L, Ricard D, Bompaire F, Ohlmann C, Sallansonnet-Froment M, Ciron J, Biotti D, Pignolet B, Parienti JJ, Defer G. Real-World Effectiveness of Natalizumab Extended Interval Dosing in a French Cohort. Neurol Ther 2023; 12:529-542. [PMID: 36763307 PMCID: PMC10043118 DOI: 10.1007/s40120-023-00440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Natalizumab, a therapy for relapsing-remitting multiple sclerosis (RRMS), is associated with a risk of progressive multifocal leukoencephalopathy (PML). Over the last several years, practitioners have used off-label extended interval dosing (EID) of natalizumab to reduce PML risk, despite the absence of a large-scale efficacy evaluation. METHODS We conducted a retrospective, multicenter cohort study among adults with RRMS receiving stable standard interval dosing (SID), defined as a ≥ 12-month consecutive period of ≥ 11 natalizumab infusions/year in France. We compared the 12-month risk difference of remaining relapse-free (primary endpoint) between patients who switched to EID (≤ 9 natalizumab infusions) and those who remained on SID, with a noninferiority margin of - 11%. We used propensity score methods such as inverse probability treatment weighting (IPTW) and 1:1 propensity score matching (PSM). Secondary endpoints were annualized relapse rate, disease progression, and safety. RESULTS Baseline characteristics were similar between patients receiving EID (n = 147) and SID (n = 156). The proportion of relapse-free patients 12 months postbaseline was 142/147 in the EID (96.6%) and 144/156 in the SID group (92.3%); risk difference (95% CI) 4.3% (- 1.3 to 9.8%); p < 0.001 for non-inferiority. There were no significant differences between relapse rates (0.043 vs. 0.083 per year, respectively; p = 0.14) or Expanded Disability Status Scale mean scores (2.43 vs. 2.72, respectively; p = 0.18); anti-JC virus index values were similar (p = 0.23); and no instances of PML were reported. The comparisons using IPTW (n = 306) and PSM (n = 204) were consistent. CONCLUSION These results support the pertinence of using an EID strategy for RRMS patients treated with natalizumab. CLINICAL TRIALS gov identifier (NCT04580381).
Collapse
Affiliation(s)
- Juliette Pelle
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Service de Neurologie, CHU de la Côte de Nacre, 14000, Caen, France
| | - Anais R Briant
- Unité de Biostatistiques et de Recherche Clinique, CHU de Caen-Cote de Nacre, Caen, France
| | - Pierre Branger
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Service de Neurologie, CHU de la Côte de Nacre, 14000, Caen, France
| | - Nathalie Derache
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Service de Neurologie, CHU de la Côte de Nacre, 14000, Caen, France
| | - Charlotte Arnaud
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Service de Neurologie, CHU de la Côte de Nacre, 14000, Caen, France
| | - Christine Lebrun-Frenay
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Unité de Recherche Clinique Côte d'azur (UR2CA), Équipe URRIS, CHU Pasteur 2, Nice, France
| | - Mikael Cohen
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Unité de Recherche Clinique Côte d'azur (UR2CA), Équipe URRIS, CHU Pasteur 2, Nice, France
| | - Lydiane Mondot
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Unité de Recherche Clinique Côte d'azur (UR2CA), Équipe URRIS, CHU Pasteur 2, Nice, France
| | - Jerome De Seze
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Département de Neurologie, CHRU de Strasbourg Hôpital de Hautepierre, Strasbourg, France
| | - Kevin Bigaut
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Département de Neurologie, CHRU de Strasbourg Hôpital de Hautepierre, Strasbourg, France
| | - Nicolas Collongues
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Département de Neurologie, CHRU de Strasbourg Hôpital de Hautepierre, Strasbourg, France
| | - Laurent Kremer
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Département de Neurologie, CHRU de Strasbourg Hôpital de Hautepierre, Strasbourg, France
| | - Damien Ricard
- Département de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Flavie Bompaire
- Département de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Charlotte Ohlmann
- Département de Radiologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Magali Sallansonnet-Froment
- Département de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Jonathan Ciron
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP)-Département des Neurosciences, CHU Toulouse-Purpan, and Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Damien Biotti
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP)-Département des Neurosciences, CHU Toulouse-Purpan, and Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Beatrice Pignolet
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP)-Département des Neurosciences, CHU Toulouse-Purpan, and Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Jean-Jacques Parienti
- Unité de Biostatistiques et de Recherche Clinique, CHU de Caen-Cote de Nacre, Caen, France
| | - Gilles Defer
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Service de Neurologie, CHU de la Côte de Nacre, 14000, Caen, France.
| |
Collapse
|
10
|
Toorop AA, van Kempen ZLE, Steenhuis M, Nielsen J, Sinnige LGF, van Dijk G, Roosendaal CM, Arnoldus EPJ, Hoitsma E, Lissenberg-Witte BI, de Jong BA, Oosten BWV, Strijbis EMM, Uitdehaag BMJ, Rispens T, Killestein J. Decrease of natalizumab drug levels after switching from intravenous to subcutaneous administration in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:482-486. [PMID: 36639226 DOI: 10.1136/jnnp-2022-330467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Natalizumab is effective in the treatment of multiple sclerosis (MS). In 2021, the European Medicines Agency approved the subcutaneous (SC) variant of natalizumab which can be used instead of intravenous administration. However, the course of drug levels varies between administration routes, and the Food and Drug Administration rejected the request for approval of natalizumab SC for reasons that were not disclosed. Our objective was to evaluate the course of natalizumab trough drug levels in patients who switched from natalizumab intravenous to SC on various treatment intervals. METHODS The NEXT-MS trial (N=382) investigates personalised treatment of natalizumab, in which infusion intervals are prolonged based on individual natalizumab trough drug levels. In 2021, an amendment was approved allowing participants to switch from intravenous to SC administration with frequent measurements of natalizumab drug levels and antidrug antibodies (ADAs). Results were compared with linear mixed model analyses. RESULTS Until December 2022, 15 participants switched to SC natalizumab. Natalizumab drug levels with SC administration were on average 55% lower compared with intravenous administration (Exp (estimate) 0.45, 95% CI 0.39 to 0.53, p<0.001), leading to very low trough drug levels in three patients on extended treatment intervals. No natalizumab ADAs were detected during intravenous or SC treatment. None of the participants on natalizumab SC showed evidence of MS disease activity. CONCLUSIONS Natalizumab trough drug levels can decrease after switching from natalizumab intravenous to SC administration. We advise to monitor trough drug levels in patients with low natalizumab drug levels during intravenous treatment, patients with higher body mass index or patients on extended treatment intervals who switch to SC administration of natalizumab.
Collapse
Affiliation(s)
- Alyssa A Toorop
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Maurice Steenhuis
- Biologics Laboratory, Department of Immunopathology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Jessica Nielsen
- Department of Neurology, Ommelander Hospital Groningen, Scheemda, The Netherlands
| | - L G F Sinnige
- Department of Neurology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Gert van Dijk
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Edo P J Arnoldus
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Elske Hoitsma
- Department of Neurology, Alrijne Hospital, Leiden, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Brigit A de Jong
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Bob W van Oosten
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Eva M M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Biologics Laboratory, Department of Immunopathology, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Landsteiner Laboratory, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | | |
Collapse
|
11
|
Auer M, Bauer A, Oftring A, Rudzki D, Hegen H, Bsteh G, Di Pauli F, Berek K, Zinganell A, Berger T, Reindl M, Deisenhammer F. Soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) and Natalizumab Serum Concentration as Potential Biomarkers for Pharmacodynamics and Treatment Response of Patients with Multiple Sclerosis Receiving Natalizumab. CNS Drugs 2022; 36:1121-1131. [PMID: 36173556 DOI: 10.1007/s40263-022-00953-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Natalizumab (NTZ) is an established treatment for highly active, relapsing-remitting multiple sclerosis. In the context of rare progressive multifocal leukoencephalopathy and extended interval dosing as a treatment option, biomarkers for treatment monitoring are required. Natalizumab serum concentration (NTZ SC) and soluble vascular cell adhesion molecule 1 (sVCAM-1) concentration were shown to change on treatment with NTZ. We aimed to investigate whether NTZ SC and sVCAM-1 could be suitable pharmacodynamic markers and whether they could predict disease activity on NTZ, improving the concept of personalized multiple sclerosis treatment. METHODS In a retrospective study at the Medical University of Innsbruck, Austria, we identified patients treated with NTZ and chose samples longitudinally collected during routine follow-ups for the measurement of NTZ SC and sVCAM-1 by an enzyme-linked immunosorbent assay. We correlated these with clinical and demographic variables and clinical outcomes. Furthermore, we analyzed the stability of NTZ SC and sVCAM-1 during treatment. RESULTS One hundred and thirty-seven patients were included. We found a strong negative correlation between NTZ SC and sVCAM-1. Both showed significant associations with body mass index, infusion interval, sample age, and anti-drug-antibodies. Natalizumab serum concentration was reduced in extended interval dosing, but not sVCAM-1. Only sVCAM-1 showed a weak association with relapses during treatment, while there was no association with disease progression. Both NTZ SC and sVCAM-1 showed a wide inter-individual distribution while levels in single patients were stable on treatment. CONCLUSIONS Soluble vascular cell adhesion molecule 1 is a suitable pharmacodynamic marker during treatment with NTZ, which is significantly reduced already after the first dose, remains stable in individual patients even on extended interval dosing, and strongly correlates with NTZ SC. Because of the high inter-individual range, absolute levels of sVCAM-1 and NTZ SC are difficult to introduce as treatment monitoring biomarkers in order to predict disease activity in single patients.
Collapse
Affiliation(s)
- Michael Auer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Angelika Bauer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Antonia Oftring
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Dagmar Rudzki
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Anne Zinganell
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Austria
| | - Markus Reindl
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Florian Deisenhammer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| |
Collapse
|
12
|
McManus EJ, Clark KM, Frampton C, Macniven JAB, Schepel J. Extended Interval Dosing Natalizumab and impact on neuropsychological deficits in Relapsing-Remitting Multiple Sclerosis. Mult Scler J Exp Transl Clin 2022; 8:20552173211070752. [PMID: 35223079 PMCID: PMC8874183 DOI: 10.1177/20552173211070752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Cognitive impairment and neuropsychiatric symptoms are frequently reported in Relapsing-Remitting Multiple Sclerosis (RRMS). Natalizumab (NTZ) is usually administered on a 4-weekly Standard Interval Dosing (SID) schedule. However, Extended Interval Dosing (EID) at 6–8 weekly intervals has been proven non-inferior regarding relapse risk, with a lower risk of Progressive Multifocal Leukoencephalopathy (PML). The impact of EID NTZ on neuropsychological deficits in RRMS has not been studied. Objective: To determine if EID NTZ demonstrates an improvement in neuropsychological parameters in RRMS patients. Method: We performed a retrospective, observational analysis of 34 RRMS patients treated between August 2015–2017. Patients underwent baseline neuropsychological testing before commencing EID NTZ. A second evaluation was performed, on average 28 months after commencing treatment. Results: Z scores at the initial assessment showed baseline cognitive impairment in multiple domains. 14/20 Z-scores showed an improvement post-NTZ and 5/14 reached statistical significance; namely Trails A (visual attention/processing speed), Line-orientation (visual-spatial), Picture-naming (word finding), Digital-Span (attention, executive function and memory) and Story-recall (memory). The Hospital Anxiety and Depression Scale (HADS) data remained unchanged. Correlation matrix showed no association between HADS scores, the time between assessments and the changes in Z scores. Conclusion: This data suggests the efficacy of EID NTZ in improving cognitive impairment in RRMS. A prospective observational study is warranted.
Collapse
Affiliation(s)
- Eileen J McManus
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | - Karen M Clark
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | | | | | - Jan Schepel
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| |
Collapse
|
13
|
van Kempen ZLE, Toorop AA, Sellebjerg F, Giovannoni G, Killestein J. Extended dosing of monoclonal antibodies in multiple sclerosis. Mult Scler 2021; 28:2001-2009. [PMID: 34949134 DOI: 10.1177/13524585211065711] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past two decades, treatment options for patients with multiple sclerosis (MS) have increased exponentially. In the current therapeutic landscape, "no evidence of MS disease activity" is within reach in many of our patients. Minimizing risks of complications, improving treatment convenience, and decreasing health care costs are goals that are yet to be reached. One way to optimize MS therapy is to implement personalized or extended interval dosing. Monoclonal antibodies are suitable candidates for personalized dosing (by therapeutic drug monitoring) or extended interval dosing. An increasing number of studies are performed and underway reporting on altered dosing intervals of anti-α4β1-integrin treatment (natalizumab) and anti-CD20 treatment (ocrelizumab, rituximab, and ofatumumab) in MS. In this review, current available evidence regarding personalized and extended interval dosing of monoclonal antibodies in MS is discussed with recommendations for future research and clinical practice.
Collapse
Affiliation(s)
- Zoé LE van Kempen
- MS Center Amsterdam, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| | - Alyssa A Toorop
- MS Center Amsterdam Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gavin Giovannoni
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Joep Killestein
- MS Center Amsterdam Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Serra López-Matencio JM, Pérez García Y, Meca-Lallana V, Juárez-Sánchez R, Ursa A, Vega-Piris L, Pascual-Salcedo D, de Vries A, Rispens T, Muñoz-Calleja C. Evaluation of Natalizumab Pharmacokinetics and Pharmacodynamics: Toward Individualized Doses. Front Neurol 2021; 12:716548. [PMID: 34690914 PMCID: PMC8529019 DOI: 10.3389/fneur.2021.716548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Plasma concentration of natalizumab falls above the therapeutic threshold in many patients who, therefore, receive more natalizumab than necessary and have higher risk of progressive multifocal leukoencephalopathy. Objective: To assess in a single study the individual and treatment characteristics that influence the pharmacokinetics and pharmacodynamics of natalizumab in multiple sclerosis (MS) patients in the real-world practice. Methods: Prospective observational study to analyse the impact of body weight, height, body surface area, body mass index, gender, age, treatment duration, and dosage scheme on natalizumab concentrations and the occupancy of α4-integrin receptor (RO) by natalizumab. Results: Natalizumab concentrations ranged from 0.72 to 67 μg/ml, and RO from 26 to 100%. Body mass index inversely associated with natalizumab concentration (beta = −1.78; p ≤ 0.001), as it did body weight (beta = −0.34; p = 0.001), but not height, body surface area, age or gender Extended vs. standard dose scheme, but not treatment duration, was inversely associated with natalizumab concentration (beta = −7.92; p = 0.016). Similar to natalizumab concentration, body mass index (beta = −1.39; p = 0.001) and weight (beta = −0.31; p = 0.001) inversely impacted RO. Finally, there was a strong direct linear correlation between serum concentrations and RO until 9 μg/ml (rho = 0.71; p = 0.003). Nevertheless, most patients had higher concentrations of natalizumab resulting in the saturation of the integrin. Conclusions: Body mass index and dosing interval are the main variables found to influence the pharmacology of natalizumab. Plasma concentration of natalizumab and/or RO are wide variable among patients and should be routinely measured to personalize treatment and, therefore, avoid either over and underdosing.
Collapse
Affiliation(s)
| | | | | | | | - Angeles Ursa
- Servicio de Inmunología, Hospital de La Princesa, Madrid, Spain
| | | | | | - Annick de Vries
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Cecilia Muñoz-Calleja
- Servicio de Inmunología, Hospital de La Princesa, Madrid, Spain.,School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
15
|
Proschmann U, Haase R, Inojosa H, Akgün K, Ziemssen T. Drug and Neurofilament Levels in Serum and Breastmilk of Women With Multiple Sclerosis Exposed to Natalizumab During Pregnancy and Lactation. Front Immunol 2021; 12:715195. [PMID: 34512637 PMCID: PMC8426350 DOI: 10.3389/fimmu.2021.715195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/05/2021] [Indexed: 12/28/2022] Open
Abstract
Objective To determine the transfer of the monoclonal antibody natalizumab into breastmilk and to evaluate drug and serum neurofilament light chain ((s)NfL) levels in natalizumab exposed pregnancies and lactation periods. Methods Eleven women with relapsing remitting multiple sclerosis treated with natalizumab during pregnancy and lactation were included in this study. Breastmilk samples were collected up to 302 days after delivery and analyzed for natalizumab concentration and NfL. Additionally, maternal drug levels and sNfL were determined preconceptually, in each trimester, at delivery and postpartum. Clinical and radiological disease activity was systemically assessed across pregnancy and postpartum period. Results The mean average natalizumab concentration in breast milk was low at 0.06 µg/ml [standard deviation (SD) 0.05] in the eight patients who provided serial breastmilk samples with an estimated mean absolute infant dose of 0.007 mg/kg/d (SD 0.005). The relative infant dose (RID), a metric comparing the infant with maternal drug exposure was low as well with a mean of 0.04% (SD=0.03). Most patients had a maximum concentration in breast milk at one to eight days after infusion. Pregnancy was associated with a non-significant decline of the median natalizumab serum concentration. All patients exposed to natalizumab prior (n=10) and during pregnancy (n=11) kept free of disease activity during gestation. While pregnancy was associated with low sNfL levels in patients treated with natalizumab prior and during pregnancy, the postpartum period was linked to a transient sNfL increase in some patients without any evidence of clinical or radiological disease activity. NfL was detectable in the majority of breastmilk samples with a median concentration of 1.7 pg/ml (range 0.004-18.1). Conclusion We determined transfer of natalizumab into breastmilk with an RID far below the threshold of concern of 10%. Studies including childhood development assessment are needed in order to gain safety data about natalizumab-exposed breastfeeding. SNfL assessment might be a useful adjunct to monitor silent disease activity and therapeutic response during pregnancy and postpartum period. However, further investigations regarding transient postpartum sNfL increases are required to determine its association to parturition per se or to a silent disease activity in people with multiple sclerosis.
Collapse
Affiliation(s)
- Undine Proschmann
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Rocco Haase
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Hernan Inojosa
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Katja Akgün
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Tjalf Ziemssen
- Multiple Sclerosis Center, Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| |
Collapse
|
16
|
Chisari CG, Grimaldi LM, Salemi G, Ragonese P, Iaffaldano P, Bonavita S, Sparaco M, Rovaris M, D'Arma A, Lugaresi A, Ferrò MT, Grossi P, Di Sapio A, Cocco E, Granella F, Curti E, Lepore V, Trojano M, Patti F. Clinical effectiveness of different natalizumab interval dosing schedules in a large Italian population of patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2020; 91:1297-1303. [PMID: 33055141 DOI: 10.1136/jnnp-2020-323472] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/16/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Natalizumab (NTZ) is one of the most effective treatment options for multiple sclerosis (MS) treatment. Our study aimed to evaluate the effectiveness of NTZ when administered according to the extended dosing strategy compared with standard 4-weekly administration in a large Italian MS population. MATERIALS AND METHODS This retrospective multicentre study included patients with relapsing-remitting MS (RR-MS) who received NTZ administrations between the 1 June 2012 and the 15 May 2018 and were followed by the 'Italian MS Register'. All patients with MS were stratified into two groups based on NTZ administration schedule: standard interval dosing (SID) patients who received infusions on average from 28 to 32 days (median 30) and extended interval dosing (EID) including patients who have been infused with interval between 33 and 49 days (median 43). Clinical data were assessed at baseline (before starting NTZ), after 12 (T1) and 24 months (T2) of treatment. RESULTS Out of 5231 patients with RR-MS screened, 2092 (mean age 43.2±12.0, 60.6% women) were enrolled. A total of 1254 (59.9%) received NTZ according to SID, and 838 (40.1%) according to EID. At 12 and 24 months, no differences in terms of annualised relapse rate and disability status were found between the two groups. Progression index and confirmed disability worsening were similar between the two groups. DISCUSSION The use of NTZ with an extended interval schedule showed similar effectiveness compared with SID. Unchanged clinical efficacy of EID schedule may raise the question of a possible advantage in terms of tolerability and safety.
Collapse
Affiliation(s)
- Clara Grazia Chisari
- Department of Surgical and Medical Sciences Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | - Luigi Maria Grimaldi
- Neurology Unit, Fondazione Istituto San Raffaele G. Giglio di Cefalù, Cefalu, Sicily, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Università degli Studi di Palermo, Palermo, Sicilia, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Università degli Studi di Palermo, Palermo, Sicilia, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Università degli Studi di Bari Aldo Moro, Bari, Puglia, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Campania, Italy
| | - Maddalena Sparaco
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Campania, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center and Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Alessia D'Arma
- Multiple Sclerosis Center and Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Emilia-Romagna, Italy.,Istituto delle Scienze Neurologiche di Bologna, Unità Operative Semplici d'Istituto (UOSI) Riabilitazione Sclerosi Multipla, Bologna, Italy
| | - Maria Teresa Ferrò
- Neurology Unit, Presidio Ospedale Maggiore di Crema, Crema, Lombardia, Italy
| | - Paola Grossi
- Neurology Unit, Presidio Ospedale Maggiore di Crema, Crema, Lombardia, Italy
| | - Alessia Di Sapio
- Department of Neurology, Ospedale Regina Montis Regalis-ASLCN1, Presidio di Mondovì Ceva, Mondovi, Piedmont, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre Binaghi Hospital, ATS Sardegna, University of Cagliari, Cagliari, Sardegna, Italy
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Emilia-Romagna, Italy
| | - Erica Curti
- Neurosciences Unit, Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Emilia-Romagna, Italy
| | - Vito Lepore
- Istituto di Ricerche Farmacologiche Mario Negri Sede di Milano, Milano, Lombardia, Italy.,Coreserach Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Università degli Studi di Bari Aldo Moro, Bari, Puglia, Italy
| | - Francesco Patti
- Department of Surgical and Medical Sciences Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
| | | |
Collapse
|
17
|
Khoy K, Mariotte D, Defer G, Petit G, Toutirais O, Le Mauff B. Natalizumab in Multiple Sclerosis Treatment: From Biological Effects to Immune Monitoring. Front Immunol 2020; 11:549842. [PMID: 33072089 PMCID: PMC7541830 DOI: 10.3389/fimmu.2020.549842] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
Abstract
Multiple sclerosis is a chronic demyelinating disease of the central nervous system (CNS) with an autoimmune component. Among the recent disease-modifying treatments available, Natalizumab, a monoclonal antibody directed against the alpha chain of the VLA-4 integrin (CD49d), is a potent inhibitor of cell migration toward the tissues including CNS. It potently reduces relapses and active brain lesions in the relapsing remitting form of the disease. However, it has also been associated with a severe infectious complication, the progressive multifocal leukoencephalitis (PML). Using the standard protocol with an injection every 4 weeks it has been shown by a close monitoring of the drug that trough levels soon reach a plateau with an almost saturation of the target cell receptor as well as a down modulation of this receptor. In this review, mechanisms of action involved in therapeutic efficacy as well as in PML risk will be discussed. Furthermore the interest of a biological monitoring that may be helpful to rapidly adapt treatment is presented. Indeed, development of anti-NAT antibodies, although sometimes unapparent, can be detected indirectly by normalization of CD49d expression on circulating mononuclear cells and might require to switch to another drug. On the other hand a stable modulation of CD49d expression might be useful to follow the circulating NAT levels and apply an extended interval dose scheme that could contribute to limiting the risk of PML.
Collapse
Affiliation(s)
- Kathy Khoy
- Laboratory of Immunology, Department of Biology, CHU Caen Normandie, Caen, France
| | - Delphine Mariotte
- Laboratory of Immunology, Department of Biology, CHU Caen Normandie, Caen, France
| | - Gilles Defer
- Department of Neurology, MS Expert Centre, CHU Caen Normandie, Caen, France.,UMR-S1237, Physiopathology and Imaging of Neurological Disorders, INSERM, Caen, France.,Normandie Université, UNICAEN, Caen, France
| | - Gautier Petit
- Laboratory of Immunology, Department of Biology, CHU Caen Normandie, Caen, France
| | - Olivier Toutirais
- Laboratory of Immunology, Department of Biology, CHU Caen Normandie, Caen, France.,UMR-S1237, Physiopathology and Imaging of Neurological Disorders, INSERM, Caen, France.,Normandie Université, UNICAEN, Caen, France
| | - Brigitte Le Mauff
- Laboratory of Immunology, Department of Biology, CHU Caen Normandie, Caen, France.,UMR-S1237, Physiopathology and Imaging of Neurological Disorders, INSERM, Caen, France.,Normandie Université, UNICAEN, Caen, France
| |
Collapse
|
18
|
Jakimovski D, Vaughn CB, Eckert S, Zivadinov R, Weinstock-Guttman B. Long-term drug treatment in multiple sclerosis: safety success and concerns. Expert Opin Drug Saf 2020; 19:1121-1142. [PMID: 32744073 DOI: 10.1080/14740338.2020.1805430] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The portfolio of multiple sclerosis (MS) disease modifying treatments (DMTs) has significantly expanded over the past two decades. Given the lifelong use of MS pharmacotherapy, understanding their long-term safety profiles is essential in determining suitable and personalized treatment. AREAS COVERED In this narrative review, we summarize the short-, mid-, and long-term safety profile of currently available MS DMTs categories. In addition to the initial trial findings, safety outcomes derived from long-term extension studies (≥5-20 years) and safety-based prescription programs have been reviewed. In order to better understand the risk-benefit ratio for each particular DMT group, a short description of the DMT-based efficacy outcomes has been included. EXPERT OPINION Long-term extension trials, large observational studies and real-world databases allow detection of rare and potentially serious adverse events. Two-year-long trials are unable to fully capture the positive and negative effects of immune system modulation and reconstitution. DMT-based monitoring programs can provide greater insights regarding safe use of MS medications in different patient populations and clinical settings. During the process of shared DMT decision, both MS care providers and their patients should be aware of an ever-expanding number of drug-based adverse events and their influence on the risk-benefit analysis.
Collapse
Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York , Buffalo, NY, USA
| | - Caila B Vaughn
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo , Buffalo, NY, USA
| | - Svetlana Eckert
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo , Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York , Buffalo, NY, USA.,Translational Imaging Center at Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Stat37$e University of New York , Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo , Buffalo, NY, USA
| |
Collapse
|
19
|
Kharlamova N, Hermanrud C, Dunn N, Ryner M, Hambardzumyan K, Vivar Pomiano N, Marits P, Gjertsson I, Saevarsdottir S, Pullerits R, Fogdell-Hahn A. Drug Tolerant Anti-drug Antibody Assay for Infliximab Treatment in Clinical Practice Identifies Positive Cases Earlier. Front Immunol 2020; 11:1365. [PMID: 32793189 PMCID: PMC7385065 DOI: 10.3389/fimmu.2020.01365] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/28/2020] [Indexed: 01/14/2023] Open
Abstract
A subgroup of patients treated with infliximab lose response to the treatment and one reason for this is the development of anti-drug antibodies (ADA). If used optimally, measuring drug and ADA level could lead to a more personalized and efficient treatment regime, and enable identification of ADA-positive patients before the underlying disease flares or allergic reactions occur. With the use of a drug-tolerant ADA assay which can detect ADA irrespective of drug levels in the sample, we determined the impact of ADA on treatment failure to infliximab. The aims of this study were to estimate the real-life optimal serum infliximab (sIFX) level and set a clinical threshold value for a drug-tolerant ADA assay. Trough levels of sIFX were measured with ELISA. Free ADA was measured with two drug-sensitive methods (ELISA and a bioassay) and one drug-tolerant method (PandA). Two real-life cohorts treated with infliximab were included; a cross-sectional cohort including patients with inflammatory rheumatic diseases (n = 270) and a prospective cohort of rheumatoid arthritis (RA) patients (n = 73) followed for 1 year. Normal range of sIFX was estimated from the prospective cohort and an arbitrary optimal drug level was set to be between 1 and 6 μg/mL. Using this range, optimal sIFX was found in only 60% (163/270) of the patients in the cross-sectional cohort. These patients had significantly better treatment response than those with a drug level under 1 μg/mL, who had an ADA frequency of 34% (19/56) using the drug-tolerant method. In the prospective cohort, the drug-tolerant assay could identify 34% (53/155 samples) as ADA positive in samples with sIFX level >0.2 μg/mL. ADA were seldom detected in patients with >1 μg/mL sIFX, with three interesting exceptions. A clinically relevant ADA threshold was determined to be >3 RECL as measured with the drug-tolerant assay. In a real-life setting, there was a substantial number of patients with suboptimal drug levels and a proportion of these had ADA. Both too low and too high drug levels correlated with worse disease, but for different reasons. Adding a drug-tolerant assay enabled detection of ADA earlier and regardless of drug level at time of sampling.
Collapse
Affiliation(s)
- Nastya Kharlamova
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| | - Christina Hermanrud
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| | - Nicky Dunn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| | - Malin Ryner
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| | - Karen Hambardzumyan
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Nancy Vivar Pomiano
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Per Marits
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Saedis Saevarsdottir
- Rheumatology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Rille Pullerits
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Fogdell-Hahn
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Stockholm, Sweden
| |
Collapse
|
20
|
van Kempen ZLE, Hoogervorst ELJ, Wattjes MP, Kalkers NF, Mostert JP, Lissenberg-Witte BI, de Vries A, Ten Brinke A, van Oosten BW, Barkhof F, Teunissen CE, Uitdehaag BMJ, Rispens T, Killestein J. Personalized extended interval dosing of natalizumab in MS: A prospective multicenter trial. Neurology 2020; 95:e745-e754. [PMID: 32690785 DOI: 10.1212/wnl.0000000000009995] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/06/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To determine whether natalizumab efficacy is maintained when switching to personalized extended interval dosing based on individual natalizumab trough concentrations in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS This was a prospective multicenter single-arm trial with 1 year follow-up and a 1-year extension phase. Participants were adult persons with RRMS treated with natalizumab without disease activity in the year prior to enrollment. The natalizumab treatment interval was based on longitudinal natalizumab trough concentrations. Patients received 3 monthly MRI scans, relapse assessments, and disability scoring during follow-up. The primary endpoint was the occurrence of gadolinium-enhancing lesions on MRI. Secondary endpoints were new/enlarging T2 lesions on MRI and relapses and progression on the Expanded Disability Status Scale (EDSS) during follow-up and extension phase. RESULTS Sixty-one patients were included. Eighty-four percent extended the interval from a 4-week interval to a 5- to 7-week interval. No patient developed gadolinium-enhancing lesions (95% confidence interval [CI] 0%-7.4%) during follow-up. No new/enlarging T2 lesions (95% CI 0%-7.4%) or relapses (95% CI 0%-7.4%) were reported during follow-up and in the extension phase. Median EDSS was comparable at baseline (3.0, interquartile range [IQR] 2.0-5.0) and after follow-up (3.0, IQR 2.0-5.0). CONCLUSION Personalized extended interval dosing did not induce recurrence of MS disease activity. Natalizumab efficacy was maintained in stable patients with RRMS receiving personalized extended interval dosing based on individual natalizumab concentrations. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that personalized extended interval dosing of natalizumab does not result in recurrence of disease activity in stable patients with RRMS.
Collapse
Affiliation(s)
- Zoé L E van Kempen
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK.
| | - Erwin L J Hoogervorst
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Mike P Wattjes
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Nynke F Kalkers
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Jop P Mostert
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Birgit I Lissenberg-Witte
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Annick de Vries
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Anja Ten Brinke
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Bob W van Oosten
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Frederik Barkhof
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Charlotte E Teunissen
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Bernard M J Uitdehaag
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Theo Rispens
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| | - Joep Killestein
- From the Department of Neurology, Amsterdam MS Center (Z.L.E.v.K., B.W.v.O., B.M.J.U., J.K.), Department of Radiology (M.P.W., F.B.), and Neurochemistry Lab and Biobank, Department of Clinical Chemistry (C.E.T.), Amsterdam Neuroscience, and Department of Epidemiology and Biostatistics (B.I.L.-W.), Amsterdam University Medical Centers, Vrije Universiteit; Department of Neurology (E.L.J.H.), St. Antonius Hospital, Utrecht, the Netherlands; Department of Diagnostic and Interventional Neuroradiology (M.P.W.), Hannover Medical School, Germany; Department of Neurology (N.F.K.), OLVG Hospital, Amsterdam; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Biologics Lab, Bioanalysis (A.d.V.), Sanquin Diagnostic Services; Department of Immunopathology (A.t.B., T.R.), Sanquin Research, Amsterdam; Landsteiner Laboratory (A.t.B., T.R.), Academic Medical Centre, University of Amsterdam, the Netherlands; and UCL Institutes of Neurology & Healthcare Engineering (F.B.), Queen Square, London, UK
| |
Collapse
|
21
|
Zhovtis Ryerson L, Li X, Goldberg JD, Hoyt T, Christensen A, Metzger RR, Kister I, Foley J. Pharmacodynamics of natalizumab extended interval dosing in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/2/e672. [PMID: 32019876 PMCID: PMC7057061 DOI: 10.1212/nxi.0000000000000672] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/23/2019] [Indexed: 01/11/2023]
Abstract
Objective To determine if the concentration and saturation of natalizumab (NTZ) administration at extended interval dosing (EID; every 5–8 weeks) over 18 months is able to be maintained in the range considered adequate to sustain the clinical efficacy of NTZ. Methods In a cross-sectional assessment of patients with multiple sclerosis (MS) who received standard interval dosing (every 4 weeks) or EID, serum NTZ concentrations were measured using ELISA, and α4-integrin receptor saturations were analyzed via cytometry, in blood samples obtained at trough timepoints. Results Trough serum concentration was above the “therapeutic” concentration of 2.0 μg/mL in 72% of EID patients. Trough saturation was above the “therapeutic” 50% threshold in 79% of EID-treated patients. Our model predicted that at least 9 NTZ infusions/year are required to maintain adequate trough saturation and concentration levels. Higher body mass index (BMI) was a predictor of suboptimal trough saturation on EID NTZ. Conclusions Trough α4-integrin receptor saturation >50% correlated with high clinical efficacy of NTZ in previous studies. A continual treatment with EID maintains receptor saturation and concentration that are in the “therapeutic range” for most patients. This finding provides biological plausibility for the clinical efficacy of NTZ EID. Patients with higher BMI may require closer clinical and MRI follow-up.
Collapse
Affiliation(s)
- Lana Zhovtis Ryerson
- From NYU Multiple Sclerosis Comprehensive Care Center (L.Z.R., I.K.), New York; Division of Biostatistics (X.L., J.D.G.), New York University School of Medicine; and Rocky Mountain MS Research Group (T.H., A.C., R.R.M., J.F.), Salt Lake City, UT.
| | - Xiaochun Li
- From NYU Multiple Sclerosis Comprehensive Care Center (L.Z.R., I.K.), New York; Division of Biostatistics (X.L., J.D.G.), New York University School of Medicine; and Rocky Mountain MS Research Group (T.H., A.C., R.R.M., J.F.), Salt Lake City, UT
| | - Judith D Goldberg
- From NYU Multiple Sclerosis Comprehensive Care Center (L.Z.R., I.K.), New York; Division of Biostatistics (X.L., J.D.G.), New York University School of Medicine; and Rocky Mountain MS Research Group (T.H., A.C., R.R.M., J.F.), Salt Lake City, UT
| | - Tamara Hoyt
- From NYU Multiple Sclerosis Comprehensive Care Center (L.Z.R., I.K.), New York; Division of Biostatistics (X.L., J.D.G.), New York University School of Medicine; and Rocky Mountain MS Research Group (T.H., A.C., R.R.M., J.F.), Salt Lake City, UT
| | - Angel Christensen
- From NYU Multiple Sclerosis Comprehensive Care Center (L.Z.R., I.K.), New York; Division of Biostatistics (X.L., J.D.G.), New York University School of Medicine; and Rocky Mountain MS Research Group (T.H., A.C., R.R.M., J.F.), Salt Lake City, UT
| | - Ryan R Metzger
- From NYU Multiple Sclerosis Comprehensive Care Center (L.Z.R., I.K.), New York; Division of Biostatistics (X.L., J.D.G.), New York University School of Medicine; and Rocky Mountain MS Research Group (T.H., A.C., R.R.M., J.F.), Salt Lake City, UT
| | - Ilya Kister
- From NYU Multiple Sclerosis Comprehensive Care Center (L.Z.R., I.K.), New York; Division of Biostatistics (X.L., J.D.G.), New York University School of Medicine; and Rocky Mountain MS Research Group (T.H., A.C., R.R.M., J.F.), Salt Lake City, UT
| | - John Foley
- From NYU Multiple Sclerosis Comprehensive Care Center (L.Z.R., I.K.), New York; Division of Biostatistics (X.L., J.D.G.), New York University School of Medicine; and Rocky Mountain MS Research Group (T.H., A.C., R.R.M., J.F.), Salt Lake City, UT
| |
Collapse
|
22
|
Clerico M, De Mercanti SF, Signori A, Iudicello M, Cordioli C, Signoriello E, Lus G, Bonavita S, Lavorgna L, Maniscalco GT, Curti E, Lorefice L, Cocco E, Nociti V, Mirabella M, Baroncini D, Mataluni G, Landi D, Petruzzo M, Lanzillo R, Gandoglia I, Laroni A, Frangiamore R, Sartori A, Cavalla P, Costantini G, Sormani MP, Capra R. Extending the Interval of Natalizumab Dosing: Is Efficacy Preserved? Neurotherapeutics 2020; 17:200-207. [PMID: 31452081 PMCID: PMC7007494 DOI: 10.1007/s13311-019-00776-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Extending the natalizumab interval after the 24th administration could reduce the risk of progressive multifocal leukoencephalopathy (PML). The objective is to evaluate the noninferiority of the efficacy of an extended interval dosing (EID) compared with the standard interval dosing (SID) of natalizumab. It is an observational, multicenter (14 Italian centers), retrospective cohort study, starting from the 24th natalizumab infusion to the loss of follow-up or 2 years after baseline. Patients were grouped in 2 categories according to the mean number of weeks between doses: < 5 weeks, SID; ≥ 5 weeks, EID. Three hundred and sixty patients were enrolled. Median dose interval (MDI) following 24th infusion was 4.7 weeks, with a bimodal distribution (modes at 4 and 6 weeks). Two hundred and sixteen patients were in the SID group (MDI = 4.3 weeks) and 144 in the EID group (MDI 6.2 weeks). Annualized relapse rate was 0.060 (95% CI = 0.033-0.087) in the SID group and 0.039 (95% CI = 0.017-0.063) in the EID group. The non-inferiority of EID versus SID was satisfied. In conclusion, there is no evidence of a reduced efficacy of natalizumab in an EID setting. This observation confirms previous results and together with the emerging evidence of a reduced risk of PML associated to an EID, supports the need of a randomized study to assess the need to change the standard of the natalizumab dosing schedule.
Collapse
Affiliation(s)
- Marinella Clerico
- Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Regione Gonzole, 10, Orbassano, 10043, Turin, Italy
| | - Stefania Federica De Mercanti
- Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Regione Gonzole, 10, Orbassano, 10043, Turin, Italy.
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Marco Iudicello
- Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Regione Gonzole, 10, Orbassano, 10043, Turin, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, Spedali Civili of Brescia, Presidio di Montichiari, Brescia, Italy
| | - Elisabetta Signoriello
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - Giacomo Lus
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy
| | - Simona Bonavita
- Clinic of Neurology, AOU - University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Lavorgna
- Clinic of Neurology, AOU - University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Erica Curti
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Binaghi Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Viviana Nociti
- Multiple Sclerosis Center, Neuroscience Area, Neuroscience, Aging, Head and Neck and Orthopaedics Sciences Department, Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Neuroscience Area, Neuroscience, Aging, Head and Neck and Orthopaedics Sciences Department, Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Damiano Baroncini
- Centro Sclerosi Multipla - Presidio ospedaliero di Gallarate - ASST Valle Olona, Gallarate, Italy
| | - Giorgia Mataluni
- UOSD Centro di Riferimento Regionale Sclerosi Multipla - Dipartimento di Neuroscienze Policlinico Tor Vergata, Rome, Italy
| | - Doriana Landi
- UOSD Centro di Riferimento Regionale Sclerosi Multipla - Dipartimento di Neuroscienze Policlinico Tor Vergata, Rome, Italy
| | - Martina Petruzzo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Multiple Sclerosis Centre, Federico II University, Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Multiple Sclerosis Centre, Federico II University, Naples, Italy
| | - Ilaria Gandoglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research, University of Genova, Genoa, Italy
| | - Alice Laroni
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rita Frangiamore
- Department of Neuroimmunology and Neuromuscular Diseases, Neurological Institute C. Besta, IRCCS Foundation, Milan, Italy
| | - Arianna Sartori
- Neurology Unit, Azienda Sanitaria Univeristaria Integrata Clinica Neurologica, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy
| | - Paola Cavalla
- Department of Neuroscience, Città della Salute e della Scienza di Torino University Hospital, Turin, Italy
| | - Gianfranco Costantini
- Department of Neuroscience, Città della Salute e della Scienza di Torino University Hospital, Turin, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Ruggero Capra
- Multiple Sclerosis Center, Spedali Civili of Brescia, Presidio di Montichiari, Brescia, Italy
| |
Collapse
|
23
|
Traub JW, Pellkofer HL, Grondey K, Seeger I, Rowold C, Brück W, Husseini L, Häusser-Kinzel S, Weber MS. Natalizumab promotes activation and pro-inflammatory differentiation of peripheral B cells in multiple sclerosis patients. J Neuroinflammation 2019; 16:228. [PMID: 31733652 PMCID: PMC6858649 DOI: 10.1186/s12974-019-1593-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022] Open
Abstract
Background In the past, multiple sclerosis (MS) medications have been primarily designed to modulate T cell properties. Based on the emerging concept that B cells are equally important for the propagation of MS, we compared the effect of four commonly used, primarily T cell-targeting MS medications on B cells. Methods Using flow cytometry, we analyzed peripheral blood mononuclear cells (PBMC) of untreated (n = 19) and dimethyl fumarate (DMF; n = 21)-, fingolimod (FTY; n = 17)-, glatiramer acetate (GA; n = 18)-, and natalizumab (NAT; n = 20)-treated MS patients, focusing on B cell maturation, differentiation, and cytokine production. Results While GA exerted minor effects on the investigated B cell properties, DMF and FTY robustly inhibited pro-inflammatory B cell function. In contrast, NAT treatment enhanced B cell differentiation, activation, and pro-inflammatory cytokine production when compared to both intraindividual samples collected before NAT treatment initiation as well as untreated MS controls. Our mechanistic in vitro studies confirm this observation. Conclusion Our data indicate that common MS medications have differential, in part opposing effects on B cells. The observed activation of peripheral B cells upon NAT treatment may be instructive to interpret its unfavorable effect in certain B cell-mediated inflammatory conditions and to elucidate the immunological basis of MS relapses after NAT withdrawal. Trial registration Protocols were approved by the ethical review committee of the University Medical Center Göttingen (#3/4/14).
Collapse
Affiliation(s)
- Jan W Traub
- Institute of Neuropathology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany.,Department of Neurology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany
| | - Hannah L Pellkofer
- Department of Neurology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany.,Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Großhaderner Straße 9, 82152 Munich, Germany
| | - Katja Grondey
- Institute of Neuropathology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany
| | - Ira Seeger
- Institute of Neuropathology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany
| | - Christoph Rowold
- Institute of Neuropathology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany.,Department of Neurology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany
| | - Leila Husseini
- Department of Neurology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany
| | - Silke Häusser-Kinzel
- Institute of Neuropathology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany
| | - Martin S Weber
- Institute of Neuropathology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany. .,Department of Neurology, University Medical Center, Robert-Koch-Straße 40, 37099 Göttingen, Germany.
| |
Collapse
|
24
|
van Rossum JA, van Kempen ZLE, Schilder L, Lissenberg-Witte BI, Uitdehaag B, Killestein J. Abnormalities and erythroblasts in peripheral blood of multiple sclerosis patients treated with natalizumab. Mult Scler Relat Disord 2019; 36:101382. [PMID: 31546224 DOI: 10.1016/j.msard.2019.101382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/21/2019] [Accepted: 09/01/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND In natalizumab treated patients several hematopoietic abnormalities including erythroblasts, myeloblasts and neutrophilic precursors in peripheral blood have been described. So far, long term effects of the hematopoietic changes have not been reported. OBJECTIVE To describe hematopoietic abnormalities in longitudinally monitored MS patients treated with natalizumab. Patients treated with dimethyl fumarate, teriflunomide and fingolimod served as controls. Secondly, the relation between natalizumab serum levels and the occurrence of hematopoietic abnormalities was explored. METHODS 212 natalizumab treated patients were included, 91 patients with available baseline samples (998 follow-up samples) were compared with patients with dimethyl fumarate (n = 166, 1154 samples), teriflunomide (n = 38, 228 samples) and fingolimod (n = 114, 853 samples). One hundred twenty one patients without baseline samples (1952 follow-up samples) were included in the follow-up group. RESULTS More than half of all natalizumab treated patients developed hematopoietic abnormalities, almost a quarter had erythroblasts. Natalizumab use was associated with an increased risk of developing abnormalities in comparison to oral treatment, with a corrected hazard ratio of 2.3, 10.0 and 8.1 in comparison to fingolimod, dimethyl fumarate and teriflunomide respectively. No difference in developing abnormalities was observed in relation to natalizumab serum concentrations. None of the patients developed a hematologic malignancy during follow up. CONCLUSION Hematopoietic abnormalities are common during natalizumab treatment. Given the lack of consequences of this finding during long-term follow-up, it is generally justifiable to refrain from further diagnostic procedures when observing hematopoietic abnormalities in patients using natalizumab.
Collapse
Affiliation(s)
- Johannis A van Rossum
- Department of Neurology, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam University Medical Centers location VUmc, PO Box 7057, de Boelelaan 1007 MB, Amsterdam, The Netherlands.
| | - Zoé L E van Kempen
- Department of Neurology, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam University Medical Centers location VUmc, PO Box 7057, de Boelelaan 1007 MB, Amsterdam, The Netherlands
| | - Louise Schilder
- Department of Hematology, Amsterdam University Medical Centers, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistiscs, Amsterdam University Medical Centers, The Netherlands
| | - Bernard Uitdehaag
- Department of Neurology, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam University Medical Centers location VUmc, PO Box 7057, de Boelelaan 1007 MB, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam University Medical Centers location VUmc, PO Box 7057, de Boelelaan 1007 MB, Amsterdam, The Netherlands
| |
Collapse
|
25
|
Scarpazza C, De Rossi N, Tabiadon G, Turrini MV, Gerevini S, Capra R. Four cases of natalizumab-related PML: a less severe course in extended interval dosing? Neurol Sci 2019; 40:2119-2124. [DOI: 10.1007/s10072-019-03959-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/30/2019] [Indexed: 11/30/2022]
|
26
|
Yamout BI, Sahraian MA, Ayoubi NE, Tamim H, Nicolas J, Khoury SJ, Zeineddine MM. Efficacy and safety of natalizumab extended interval dosing. Mult Scler Relat Disord 2018; 24:113-116. [PMID: 29982107 DOI: 10.1016/j.msard.2018.06.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/28/2018] [Accepted: 06/19/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE It is postulated that extending the dosing interval of natalizumab (NTZ) from 4 to 5-8 weeks might decrease the risk of progressive multifocal leukoencephalopathy (PML). The aim of this study was to assess the effect of extended interval dosing (EID) on the therapeutic efficacy of natalizumab. METHODS We reviewed 85 patients treated at two MS centers in the Middle East with natalizumab for at least 6 months using EID. Patients were shifted after an initial treatment period at standard interval dosing (SID) to an EID ranging from 5-8 weeks. RESULTS The mean treatment duration on SID and EID was 15.4 ± 11.9 and 11.8 ± 7.0 months, respectively. By the end of SID and EID treatment 95.3% and 93.9% of patients were free of relapses (P = 0.41) with an annualized relapse rate (ARR) of 0.0006 and 0.001 respectively (P = 0.42). The mean EDSS at the end of SID and EID periods was 2.56 ± 1.62 and 2.59 ± 1.61 respectively (P = 0.84). A total of 97.6% and 94.7% of patients had no enhancing lesions on MRI during the SID and EID periods respectively (P = 0.18). There were no cases of PML and the rate of infections was lower during the EID period. CONCLUSION In patients treated with natalizumab, shifting from SID to EID has no negative effect on efficacy as evidenced by relapse rate, disability progression and MRI activity.
Collapse
Affiliation(s)
- Bassem I Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nabil El Ayoubi
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Johnny Nicolas
- Faculty of Medicine, American University of Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Maya M Zeineddine
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
27
|
Kleerekooper I, van Kempen ZLE, Leurs CE, Dekker I, Rispens T, Lissenberg-Witte BI, van Munster CEP, de Jong BA, van Oosten BW, Uitdehaag BMJ, Wattjes MP, Killestein J. Disease activity following pregnancy-related discontinuation of natalizumab in MS. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 5:e424. [PMID: 29379823 PMCID: PMC5778770 DOI: 10.1212/nxi.0000000000000424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/19/2017] [Indexed: 11/22/2022]
Abstract
Objective: To investigate disease activity and disability progression following pregnancy-related discontinuation of natalizumab (NTZ) in patients with relapsing-remitting MS. Methods: A retrospective cohort study of clinical and radiologic data in patients who discontinued NTZ for pregnancy-related reasons. Results: Twenty-two pregnancy-related NTZ discontinuations in 17 patients were evaluated. The median time to conception was 3.4 months. Relapses were more frequent in patients in whom conception did not occur within 6 months (p = 0.022). Confirmed disability progression occurred in 27.3% and was associated with time to conception (p < 0.001). Conclusions: Early conception after NTZ discontinuation is associated with a reduced risk of disease activity and disability progression. Continuation of NTZ treatment until confirmed pregnancy should be considered in patients with previously active MS. However, the advantages of continuing the drug until pregnancy should be balanced against the uncertainties in postnatal outcomes.
Collapse
Affiliation(s)
- Iris Kleerekooper
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Zoé L E van Kempen
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Cyra E Leurs
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Iris Dekker
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Caspar E P van Munster
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Brigit A de Jong
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Bob W van Oosten
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands
| |
Collapse
|
28
|
van Kempen ZLE, Rispens T, Killestein J. Response to "Letter to the editor on the paper: The majority of natalizumab-treated MS patients have high natalizumab concentrations at time of re-dosing". Mult Scler 2017; 24:822-823. [PMID: 28990853 PMCID: PMC5971362 DOI: 10.1177/1352458517734073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zoé LE van Kempen
- 1 Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Theo Rispens
- 2 Department of Immunology, Landsteiner Laboratory, Sanquin Research, Amsterdam, The Netherlands
| | - Joep Killestein
- 1 Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
29
|
Leurs CE, van Kempen ZLE, Dekker I, Balk LJ, Wattjes MP, Rispens T, Uitdehaag BM, Killestein J. Switching natalizumab to fingolimod within 6 weeks reduces recurrence of disease activity in MS patients. Mult Scler 2017; 24:1453-1460. [PMID: 28823223 PMCID: PMC6174622 DOI: 10.1177/1352458517726381] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Natalizumab is an effective treatment in relapsing-remitting multiple sclerosis (MS). Mainly because of the risk of progressive multifocal leukoencephalopathy (PML), a substantial proportion of John Cunningham (JC) virus-positive patients switch to fingolimod. Previous reports show a clear benefit when the duration of a washout (WO) period of natalizumab is 0-3 months in comparison to longer WO periods. However, there is no consensus regarding the optimal duration of a WO period under 3 months. OBJECTIVE We compared MS disease activity after different WO periods. In addition, we investigated several factors that possibly influence recurrence of disease activity, including serum natalizumab concentration and lymphocyte counts. METHODS From a prospective observational cohort study of natalizumab-treated patients, we selected 52 patients who switched to fingolimod. We divided the patients in three groups (<6 weeks, 6-8 weeks, >8 weeks WO). Serum natalizumab concentration and lymphocyte count were assessed during and after natalizumab treatment. RESULTS Patients with a WO period of >8 weeks had a significant higher recurrence of disease activity (odds ratio, 6.8; 95% confidence interval, 1.4-32.8) compared to patients with a WO period of <6 weeks. Serum natalizumab concentration and lymphocyte count did not predict recurrence of disease activity. INTERPRETATION A short WO period decreases the risk of recurrence of disease activity. The possible impact of a short WO period on the risk of carry-over PML in JC virus-positive patients remains uncertain.
Collapse
Affiliation(s)
- Cyra E Leurs
- Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Zoé LE van Kempen
- Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Iris Dekker
- Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands / Department of Radiology and Nuclear Medicine, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Lisanne J Balk
- Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Mike P Wattjes
- Department of Radiology and Nuclear Medicine, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunology, Landsteiner Laboratory Sanquin Research, Amsterdam, The Netherlands
| | - Bernard Mj Uitdehaag
- Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Sehr T, Proschmann U, Thomas K, Ziemssen T. Letter to the editor on the paper: "The majority of natalizumab-treated MS patients have high natalizumab concentrations at time of re-dosing". Mult Scler 2017; 24:820-822. [PMID: 28805095 DOI: 10.1177/1352458517726384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tony Sehr
- MS Center, Center of Clinical Neurosciences, Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Undine Proschmann
- MS Center, Center of Clinical Neurosciences, Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Katja Thomas
- MS Center, Center of Clinical Neurosciences, Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Tjalf Ziemssen
- MS Center, Center of Clinical Neurosciences, Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| |
Collapse
|
31
|
van Kempen ZLE, Leurs CE, de Vries A, Vennegoor A, Rispens T, Wattjes MP, Killestein J. John Cunningham virus conversion in relation to natalizumab concentration in multiple sclerosis patients. Eur J Neurol 2017; 24:1196-1199. [PMID: 28707781 DOI: 10.1111/ene.13355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Infection with the John Cunningham virus (JCV) is required for the development of progressive multifocal leukoencephalopathy, the feared complication of natalizumab treatment in multiple sclerosis patients. The JCV seroconversion rate seems higher in natalizumab treated patients than in the normal population, with an unknown cause. METHODS Natalizumab concentration was correlated to JCV antibody status and seroconversion in a large cohort of multiple sclerosis patients. RESULTS One hundred and thirty-five patients were included. No correlation was found between natalizumab concentration and JCV status, JCV seroconversion or JCV index. CONCLUSIONS Higher natalizumab concentrations do not explain the increased JCV seroconversion rate in natalizumab treated patients.
Collapse
Affiliation(s)
- Z L E van Kempen
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - C E Leurs
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - A de Vries
- Biologicals Lab, Sanquin Diagnostic Services, Sanquin, Amsterdam, The Netherlands
| | - A Vennegoor
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - T Rispens
- Department of Immunology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - M P Wattjes
- Department of Radiology & Nuclear Medicine, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - J Killestein
- Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|