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Article
Reducing return of disease activity in patients with relapsing multiple sclerosis transitioned from natalizumab to teriflunomide: 12-month interim results of teriflunomide therapy.
Mult Scler J Exp Transl Clin
  • Stanley Cohan, Providence Multiple Sclerosis Center, USA.
  • Keith Edwards
  • Lindsay Lucas, Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, USA
  • Tiffany Gervasi-Follmar, Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, USA
  • Judy O'Connor
  • Jessica Siuta
  • Vineetha Kamath
  • Lore Garten
  • Chiayi Chen, Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, USA
  • James Thomas
  • Kyle E Smoot, Providence Multiple Sclerosis Center, Providence Health & Services, 9427 SW Barnes Road, Portland, OR 97225, USA; Providence Brain and Spine Institute, Providence Health & Services, 9135 SW Barnes Road, Suite 461, Portland, OR 97225, USA
  • Kiren Kresa-Reahl, Providence Multiple Sclerosis Center, USA.
  • Kateri Spinelli, Regional Research, Providence Health and Services, USA.
Document Type
Article
Publication Date
1-1-2019
Keywords
  • Relapsing multiple sclerosis,
  • anti-JC virus antibodies,
  • disease recurrence,
  • natalizumab,
  • switch strategy,
  • teriflunomide
Disciplines
Abstract

Background: Natalizumab is an effective treatment for relapsing multiple sclerosis. Return of disease activity upon natalizumab discontinuance creates the need for follow-up therapeutic strategies.

Objective: To assess the efficacy of teriflunomide following natalizumab discontinuance in relapsing multiple sclerosis patients.

Methods: Clinically stable relapsing multiple sclerosis patients completing 12 or more consecutive months of natalizumab, testing positive for anti-John Cunningham virus antibody, started teriflunomide 14 mg/day, 28 ± 7 days after their final natalizumab infusion. Physical examination, Expanded Disability Status Scale, laboratory assessments, and brain magnetic resonance imaging were performed at screening and multiple follow-up visits.

Results: Fifty-five patients were enrolled in the study. The proportion of patients relapse-free was 0.94, restricted mean time to first gadolinium-enhancing lesion was 10.9 months and time to 3-month sustained disability worsening was 11.8 months. The mean number of new or enlarging T2 lesions per patient at 12 months was 0.42. Exploratory analyses revealed an annualized relapse rate of 0.08, and a proportion of patients with no evidence of disease activity of 0.68. Forty-seven patients (85.5%) reported adverse events, 95% of which were mild to moderate.

Conclusions: Teriflunomide therapy initiated without natalizumab washout resulted in a low rate of return of disease activity. Clinicians may consider this a worthwhile strategy when transitioning clinically stable patients off natalizumab to another therapy.ClinicalTrials.gov Identifier: NCT01970410.

Clinical Institute
Neurosciences (Brain & Spine)
Specialty
Neurosciences
Citation Information
Stanley Cohan, Keith Edwards, Lindsay Lucas, Tiffany Gervasi-Follmar, et al.. "Reducing return of disease activity in patients with relapsing multiple sclerosis transitioned from natalizumab to teriflunomide: 12-month interim results of teriflunomide therapy." Mult Scler J Exp Transl Clin (2019)
Available at: http://works.bepress.com/kateri-spinelli/63/