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ECTRIMS 2023 | Challenges in switching from natalizumab in RRMS

Maya Zeineddine, PharmD, Harley Street Medical Center, Abu Dhabi, United Arab Emirates, addresses the complexities surrounding the discontinuation of natalizumab, a highly effective disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS), primarily due to the associated risk of progressive multifocal encephalopathy (PML). While there are studies evaluating the transition from natalizumab to less potent DMTs, the ideal successor therapy remains undetermined. The RESTORE trial (NCT01071083), for instance, investigated the switch to therapies such as interferon, glatiramer acetate, or methylprednisolone, uncovering rebound activity in approximately 30% of participants. Moreover, MRI scans revealed renewed disease activity just 12 weeks post-cessation. Further studies evidenced breakthrough disease in those transitioning from natalizumab to dimethyl fumarate or teriflunomide. However, Dr Zeineddine emphasizes a gap in research concerning the shift from natalizumab to other high-efficacy DMTs, especially in stable RRMS patients seeking safer alternatives. This interview took place at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress 2023 in Milan, Italy.

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