Journal
ARCHIVES OF NEUROLOGY
Volume 69, Issue 2, Pages 239-245Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/archneurol.2011.216
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Funding
- German Research Foundation [DFG Exc 257]
- The Multiple Sclerosis Center at the Department of Neurology
- Walter-and-Ilse-Rose-Stiftung
- German Ministry for Education and Research
- The Department of Neurology
- German Competence Network Multiple Sclerosis
- Verein Therapieforschung fur MS Kranke
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Objective: To describe first experiences with the integrin inhibitor natalizumab, given to patients with suspected relapsing-remitting multiple sclerosis (MS) who were later diagnosed with aquaporin 4-positive neuromyelitis optica (NMO). Design: Retrospective case series. Setting: Neurology departments at tertiary referral centers in Germany. Patients: Patients with NMO who tested positive for antibodies to aquaporin 4. Intervention: Treatment with natalizumab. Main Outcome Measures: Relapses and accumulation of disability. Results: We identified 5 patients (4 female; median age, 45 years) who were initially diagnosed with MS and treated with natalizumab before diagnosis of NMO was established. Natalizumab was given as escalation therapy after failure of first- or second-line immunomodulatory therapies for MS. During natalizumab therapy (median duration, 8 infusions; range, 2-11 infusions), all 5 patients displayed persisting disease activity; a total of 9 relapses occurred (median duration to relapse, 120 days; range, 45-230 days) after the start of treatment. Four patients had an accumulation of disability and 1 patient died 2 months after cessation of natalizumab treatment. Conclusions: Our results suggest that natalizumab fails to control disease activity in patients with NMO. Neuromyelitis optica should be considered as a differential diagnosis in patients with suspected MS who are unresponsive to natalizumab therapy.
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