Natalizumab extended interval dosing: what about wearing-off effect?

Catarina Bernardes, Catarina Fernandes, Carolina Cunha, Carla Nunes, Carmo Macário, Lívia Sousa, Sónia Batista, Inês Correia

Journal of the neurological sciences 2024 Mar 15

filter terms:

Up to two thirds of patients with multiple sclerosis (MS) under natalizumab report a resurgence of symptoms at the end of the natalizumab cycle (wearing-off (WO) effect). At the outbreak of COVID-19, in line with the international recommendations for MS management, our centre switched all clinically stable patients on natalizumab therapy for more than one year from standard interval dosing (SID) to extended interval dosing (EID) with every six weeks infusions. This study aimed to evaluate the impact of EID in WO in MS patients under natalizumab. An observational retrospective study in patients with MS under natalizumab on EID was conducted. A questionnaire regarding current (on EID) and past (on SID) experience of WO effect was applied. Seventy-six patients were included. No significant differences were found in the annual relapse rate after the switch to EID (p = 0.083). However, there was a significant increase in the proportion of patients complaining of WO from 38.2% to 56.6% (p = 0.001). Moreover, patients with WO on SID, referred a significant increase in severity (p = 0.019) and duration of WO symptoms (p = 0.029), due to an anticipation of the symptoms relative to the day of natalizumab infusion (p = 0.019), when switching to EID. Symptoms improved with treatment maintenance in 23.3% of patients; instead, a reduction in interval dosing was needed in 54.8% with symptom improvement. WO affects a significant proportion of MS patients under natalizumab. Its prevalence, severity, and duration increase on EID, therefore despite clinical effectiveness maintenance of this posology should be individualized. Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.

Citation

Catarina Bernardes, Catarina Fernandes, Carolina Cunha, Carla Nunes, Carmo Macário, Lívia Sousa, Sónia Batista, Inês Correia. Natalizumab extended interval dosing: what about wearing-off effect? Journal of the neurological sciences. 2024 Mar 15;458:122930