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       #Post#: 275--------------------------------------------------
       (Abst.) What to expect after stopping Tysabri...
       By: agate Date: April 30, 2014, 8:32 pm
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       From PubMed via NTK Watch, April 30, 2014:
       [quote]Acta Neurol Scand. 2014 Apr 10.
       What to expect after natalizumab cessation in a real-life
       setting
       Salhofer-Polanyi S1, Baumgartner A, Kraus J, Maida E, Schmied M,
       Leutmezer F.
       Author information
       1Department of Neurology, Medical University of Vienna, Vienna,
       Austria.
       BACKGROUND:
       To minimize the risk of progressive multifocal
       leucoencephalopathy (PML), treatment with natalizumab is often
       stopped after 2 years, but evidence upon rebound of disease
       activity is limited and controversial.
       OBJECTIVE:
       To evaluate effects of natalizumab discontinuation on clinical
       disease activity within twelve months after cessation.
       METHODS:
       We retrospectively analyzed data of 201 patients with MS who
       discontinued natalizumab between 2007 and 2012. Mean change
       scores of annualized relapse rate (ARR) and expanded disability
       status scale (EDSS) were calculated for detection of rebound
       disease activity after twelve months.
       RESULTS:
       Natalizumab exposure did not exceed 2 years in 50.2% of
       patients, and the most common reasons for discontinuation were a
       long treatment period and concern of PML (56%). A total of 11.9%
       experienced a rebound phenomenon within twelve months. Mean ARR
       prenatalizumab was lower (P = 0.001, 95% CI -1.0-0.000) and
       treatment response to natalizumab poorer (P < 0.001, 95% CI
       0.4-1.3) in patients with rebound compared to those without, but
       rebound was not associated with brief exposure to natalizumab (P
       = 0.159, 95% CI -9.3-1.5). 86.1% of patients switched to another
       therapy. Patients without rebound were found more often in the
       group starting an alternative treatment early (P = 0.013).
       CONCLUSION:
       Our data suggest that rebound of MS disease activity affects a
       subgroup of patients (11.9%), especially those with low disease
       activity before natalizumab therapy and a longer treatment gap
       after its withdrawal.
       PMID: 24720783[/quote]
       The abstract can be seen here
  HTML http://www.ntkinstitute.org/news/content.nsf/PaperFrameSet?OpenForm&pp=1&id=B93AF9350C28EBD38525709B0074F231&refid=4314&specid=999&newsid=5D43C9162888311A85257CC90049.
       #Post#: 584--------------------------------------------------
       Re: (Abst.) What to expect after stopping Tysabri...
       By: agate Date: December 10, 2014, 7:51 pm
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       Another article on MS worsening after stopping Tysabri.
       From NTK Institute as it appeared in PubMed, December 10, 2014:
       [quote]Mult Scler. 2014 Nov 12.
       Significant clinical worsening after natalizumab withdrawal:
       Predictive factors
       Vidal-Jordana A1, Tintoré M1, Tur C1, Pérez-Miralles F1, Auger
       C1, Río J1, Nos C1, Arrambide G1, Comabella M1, Galán I1,
       Castilló J1, Sastre-Garriga J1, Rovira A1, Montalban X2.
       Author information
       1Hospital Universitari Vall d'Hebron, Universitat Autònoma de
       Barcelona, Barcelona, Spain.
       2Hospital Universitari Vall d'Hebron, Universitat Autònoma de
       Barcelona, Barcelona, Spain xmontalban@cem-cat.org.
       We aimed to single out multiple sclerosis (MS) cases with poor
       outcome after natalizumab withdrawal and to identify predictive
       variables. We ascertained 47 withdrawals, and compared their
       pre- and post-natalizumab periods. We objectively defined
       significant clinical worsening after natalizumab withdrawal as a
       2-step increase in Expanded Disability Status Scale (EDSS). We
       performed regression models.
       As a group, post-natalizumab annualized relapse rate (ARR) was
       lower in the post-natalizumab period, and there were no
       differences in the mean number of gadolinium (Gd)-enhancing
       lesions between pre- and post-natalizumab magnetic resonance
       imaging (MRI). Corticosteroid treatment did not change the
       outcomes.
       Eight patients (19%) presented significant clinical worsening
       after natalizumab withdrawal, which was predicted by a higher
       baseline EDSS and a 1-step EDSS increase while on
       natalizumab.[/quote]
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