Massive exacerbation of multiple sclerosis after withdrawal and early restart of treatment with natalizumab

被引:13
作者
Beume, Lena-Alexandra [1 ]
Dersch, Rick [1 ]
Fuhrer, Hannah [1 ]
Stich, Oliver [1 ]
Rauer, Sebastian [1 ]
Niesen, Wolf D. [1 ]
机构
[1] Univ Hosp Freiburg, Dept Neurol, D-79106 Freiburg, Germany
关键词
IRIS; Multiple sclerosis; Natalizumab; Plasmapheresis; Rebound; Regulatory T-cells; Restart; DISEASE-ACTIVITY; RELAPSES;
D O I
10.1016/j.jocn.2014.05.028
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
We present a 46-year-old woman with a relapse of multiple sclerosis (MS) that began 3 months after withdrawal from long-term treatment with natalizumab. Shortly after restart of a single dose of natalizumab she developed a fulminant MS rebound with stupor and tetraparesis. Cerebral MRI showed massive progression in the number of lesions and tumefactive lesions with ring gadolinium-enhancement. Stereotactic brain biopsy revealed acute demyelination and B-cell dominated inflammation. The patient improved during therapeutic plasma exchange. We speculate that early restart of natalizumab in the case of a relapse may worsen disease evolution possibly by modifying regulatory immune effector processes during an inflammatory rebound phase. A restart of natalizumab in MS patients suffering from a recent relapse or with signs of active inflammation should be considered with caution. (C) 2014 Elsevier Ltd. All rights reserved.
引用
收藏
页码:400 / 401
页数:2
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共 9 条
  • [1] Early relapses after the first dose of natalizumab in active multiple sclerosis patients
    Centonze, D.
    Furlan, R.
    Gasperini, C.
    Salvetti, M.
    Battistini, L.
    [J]. MULTIPLE SCLEROSIS JOURNAL, 2008, 14 (08) : 1137 - 1138
  • [2] CD4+T-bet+, CD4+pSTAT3+ and CD8+T-bet+ T cells accumulate in peripheral blood during NZB treatment
    Frisullo, Giovanni
    Iorio, Raffaele
    Plantone, Domenico
    Marti, Alessandro
    Nociti, Viviana
    Patanella, Agata Katia
    Batocchi, Anna Paola
    [J]. MULTIPLE SCLEROSIS JOURNAL, 2011, 17 (05) : 556 - 566
  • [3] Effect of natalizumab on clinical and radiological disease activity in multiple sclerosis: a retrospective analysis of the Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) study
    Havrdova, Eva
    Galetta, Steven
    Hutchinson, Michael
    Stefoski, Dusan
    Bates, David
    Polman, Chris H.
    O'Connor, Paul W.
    Giovannoni, Gavin
    Phillips, J. Theodore
    Lublin, Fred D.
    Pace, Amy
    Kim, Richard
    Hyde, Robert
    [J]. LANCET NEUROLOGY, 2009, 8 (03) : 254 - 260
  • [4] Disease activity return during natalizumab treatment interruption in patients with multiple sclerosis
    O'Connor, P. W.
    Goodman, A.
    Kappos, L.
    Lublin, F. D.
    Miller, D. H.
    Polman, C.
    Rudick, R. A.
    Aschenbach, W.
    Lucas, N.
    [J]. NEUROLOGY, 2011, 76 (22) : 1858 - 1865
  • [5] Treatment with Natalizumab in Relapsing-Remitting Multiple Sclerosis Patients Induces Changes in Inflammatory Mechanism
    Ramos-Cejudo, Jaime
    Oreja-Guevara, Celia
    Stark Aroeira, Luiz
    Rodriguez de Antonio, Luis
    Chamorro, Beatriz
    Diez-Tejedor, Exuperio
    [J]. JOURNAL OF CLINICAL IMMUNOLOGY, 2011, 31 (04) : 623 - 631
  • [6] Severe relapses after the first infusion of natalizumab in active relapsing-remitting multiple sclerosis
    Rinaldi, Francesca
    Perini, Paola
    Calabrese, Massimiliano
    Rinaldi, Luciano
    Gallo, Paolo
    [J]. MULTIPLE SCLEROSIS JOURNAL, 2009, 15 (11) : 1359 - 1362
  • [7] Effects of Natalizumab Treatment on Foxp3+T Regulatory Cells
    Stenner, Max-Philipp
    Waschbisch, Anne
    Buck, Dorothea
    Doerck, Sebastian
    Einsele, Hermann
    Toyka, Klaus V.
    Wiendl, Heinz
    [J]. PLOS ONE, 2008, 3 (10):
  • [8] Discordant effects of anti-VLA-4 treatment before and after onset of relapsing experimental autoimmune encephalomyelitis
    Theien, BE
    Vanderlugt, CL
    Eagar, TN
    Nickerson-Nutter, C
    Nazareno, R
    Kuchroo, VK
    Miller, SD
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 2001, 107 (08) : 995 - 1006
  • [9] Natalizumab Dosage Suspension: Are We Helping or Hurting?
    West, Timothy W.
    Cree, Bruce A. C.
    [J]. ANNALS OF NEUROLOGY, 2010, 68 (03) : 395 - 399