Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Increased disease activity in a case of multiple sclerosis after switching treatment from fingolimod to natalizumab

Ritsu Akatani, M.D.1), Norio Chihara, M.D., Ph.D.1), Kimitaka Katanazaka, M.D.1), Takehiro Ueda, M.D., Ph.D.1), Kenji Sekiguchi, M.D., Ph.D.1) and Riki Matsumoto, M.D., Ph.D.1)

1)Division of Neurology, Kobe University Graduate School of Medicine

A 42-year-old woman diagnosed with multiple sclerosis (MS) at the age of 37 was initially treated with interferon-β IM. The frequency of clinical relapses was twice in 4 years. At the age of 41, due to difficulty in administering muscle injections, an oral medication fingolimod was started. However, it was discontinued after a month due to decreased lymphocyte count, following which natalizumab was administered. The number of relapses increased 3 times in eleven months, and the number of T2 lesions on the MRI increased from 12 to 23. Natalizumab was discontinued because the test for the anti-natalizumab antibody was positive. It was suspected that both, the rebound syndrome caused by fingolimod cessation and the drug neutralization by anti-natalizumab antibodies, were associated with the exacerbation of disease activity. Thus, careful attention should be paid to potential occurrence of these events post switching between disease-modifying drugs for treating MS with high activity.
Full Text of this Article in Japanese PDF (546K)

(CLINICA NEUROL, 59: 536|540, 2019)
key words: multiple sclerosis, anti-natalizumab antibody, natalizumab, fingolimod, rebound syndrome

(Received: 1-Apr-19)