Title: Natalizumab saturation: biomarker for individual treatment holiday after natalizumab withdrawal?
Abstract: Acta Neurologica ScandinavicaVolume 129, Issue 3 p. e12-e15 Original Article Natalizumab saturation: biomarker for individual treatment holiday after natalizumab withdrawal? P. Wipfler, P. Wipfler Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaThese authors contributed equally to this work.Search for more papers by this authorA. Harrer, A. Harrer Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaThese authors contributed equally to this work.Search for more papers by this authorG. Pilz, G. Pilz Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaSearch for more papers by this authorK. Oppermann, K. Oppermann Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaSearch for more papers by this authorS. Afazel, S. Afazel Central Laboratory, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaSearch for more papers by this authorE. Haschke-Becher, E. Haschke-Becher Central Laboratory, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaSearch for more papers by this authorJ. Sellner, J. Sellner Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, GermanySearch for more papers by this authorE. Trinka, E. Trinka Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaSearch for more papers by this authorJ. Kraus, Corresponding Author J. Kraus Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria J. Kraus, Christian-Doppler-Klinik, Department of Neurology, Paracelsus Medical University, Ignaz-Harrer-Strasse 79, A-5020 Salzburg, Austria Tel.: +43-662-4483-0 Fax: +43-662-4483-3734 e-mail: [email protected]Search for more papers by this author P. Wipfler, P. Wipfler Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaThese authors contributed equally to this work.Search for more papers by this authorA. Harrer, A. Harrer Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaThese authors contributed equally to this work.Search for more papers by this authorG. Pilz, G. Pilz Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaSearch for more papers by this authorK. Oppermann, K. Oppermann Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaSearch for more papers by this authorS. Afazel, S. Afazel Central Laboratory, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaSearch for more papers by this authorE. Haschke-Becher, E. Haschke-Becher Central Laboratory, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaSearch for more papers by this authorJ. Sellner, J. Sellner Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, GermanySearch for more papers by this authorE. Trinka, E. Trinka Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, AustriaSearch for more papers by this authorJ. Kraus, Corresponding Author J. Kraus Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria J. Kraus, Christian-Doppler-Klinik, Department of Neurology, Paracelsus Medical University, Ignaz-Harrer-Strasse 79, A-5020 Salzburg, Austria Tel.: +43-662-4483-0 Fax: +43-662-4483-3734 e-mail: [email protected]Search for more papers by this author First published: 30 August 2013 https://doi.org/10.1111/ane.12182Citations: 16 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Abstract Background More and more patients with multiple sclerosis (MS) switch from natalizumab to fingolimod because of the risk of progressive multifocal leukoencephalopathy. The duration of the treatment holiday is still under debate referring to a possible recurrence of disease activity. Aim of the study The aim of this study was to evaluate the prognostic value of natalizumab saturation on T cells for the recurrence of clinical and radiological disease activity. Methods Cell surface-bound natalizumab saturation (in%) of CD8+ and CD4+ T cells from five patients with MS was determined before initiation of fingolimod by flow cytometry and related to clinical and MRI outcome during a 6-month follow-up. Results In two patients with either clinical or radiological disease activity, the natalizumab saturation on CD8+ and CD4+ T cells was <30%. In contrast, the remaining three patients with absence of disease activity had a median natalizumab saturation of 70% (range 59–79%) on CD4+ and 66% (range 52–68%) on CD8+ T cells. Conclusions The data of this pilot study indicate that clinical and radiological disease activity is closely linked to natalizumab saturation at the time point of switch. The determination of natalizumab saturation may be an essential tool to monitor cessation of natalizumab treatment. References 1Polman CH, O'Connor PW, Havrdova E et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med 2006; 354: 899– 910. 2Kappos L, Antel J, Comi G et al. Oral fingolimod (FTY720) for relapsing multiple sclerosis. N Engl J Med 2006; 355: 1124– 40. 3Gorelik L, Lerner M, Bixler S et al. Anti-JC virus antibodies: implications for PML risk stratification. Ann Neurol 2010; 68: 295– 303. 4O'Connor PW, Goodman A, Kappos L et al. Disease activity return during natalizumab treatment interruption in patients with multiple sclerosis. Neurology 2011; 76: 1858– 65. 5Havla J, Tackenberg B, Hellwig K et al. 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