PML risk stratification tool could affect natalizumab usage
EXPERT ANALYSIS FROM THE CMSC/ACTRIMS ANNUAL MEETING
Natalizumab is such an effective agent that if a patient with MS experiences breakthrough disease activity on the drug, it’s time to check for the possible presence of neutralizing antibodies to natalizumab.
"We have very good data that if somebody has formed persistent neutralizing antibodies, the drug is not working. And there’s no point in putting a patient at any extra risk for a drug that is not working," Dr. Coyle said.
A significant infusion reaction is another indicator that neutralizing antibodies may be present, she added.
What does the future hold for natalizumab?
Dr. Coyle predicted that in the short term the drug will see increasing use as physicians become comfortable with risk stratification as a means of identifying the portion of the MS population at low risk for PML. But she forecast that several years from now this highly effective medication will have fallen by the wayside.
"I think the era of natalizumab is ending," she said. "In my opinion it’s going to be supplanted by anti-CD20 agents in the next couple of years – drugs with equivalent efficacy and greater safety."
She reported having received honoraria from Biogen Idec and eight other pharmaceutical companies.
