Cyclophosphamide Pulses Therapy after Natalizumab Discontinuation for Multiple Sclerosis: A Multicentre StudyMarco Capobianco1*, Marianna Lo Re2, Francesca Sangalli3, Lucia Moiola3, Paola Perini4, Paolo Gallo4, Maura Danni5, Leandro Provinciali5, Annamaria Repice6, Luca Massacesi6, Silvia Messina7, Francesco Patti7, Alice Laroni8, Gian Luigi Mancardi9, Eugenio Pucci9, Massimiliano Calabrese10 and Antonio Bertolotto1
- *Corresponding Author:
- Marco Capobianco
Regional Multiple Sclerosis Centre, AOU San Luigi Gonzaga Orbassano
Regione Gonzole 10, 10043 Orbassano (TO), Italy
E-mail: [email protected] gmail.com
Received date: July 29, 2015; Accepted date: August 24, 2015; Published date: August 31, 2015
Citation: Capobianco M, Re ML, Sangalli F, Moiola L, Perini P, et al. (2015) Cyclophosphamide Pulses Therapy after Natalizumab Discontinuation for Multiple Sclerosis: A Multicentre Study. J Mult Scler (Foster City) 2:151.doi:10.4172/2376- 0389.1000151
Copyright: © 2015 Capobianco M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Natalizumab discontinuation induces the recurrence of Multiple Sclerosis (MS) disease activity: Currently no therapeutic approach has been found able to abolish disease reactivation. Objective: To collect data from patients with MS switching from natalizumab to cyclophosphamide. Design: Retrospective multicentre study.
Setting: Nine Multiple Sclerosis Centers in Italy. Participants: A total of 47 patients with clinically definite RR-MS switched to cyclophosphamide after natalizumab discontinuation. Two patients were excluded from the analysis because received less than 12 natalizumab infusions. The remaining 45 patients were subdivided into two main groups: Early Treatment (period of washout between natalizumab and cyclophosphamide 1 to 3 months), Late Treatment (washout between natalizumab and cyclophosphamide higher than 3 months). Intervention: Cyclophosphamide intravenous pulses after natalizumab discontinuation.
Main outcome measure: Number of relapses, Expanded Disability Status Scale scores, number of new T2/fluidattenuated inversion recovery lesions and contrast-enhancing lesions on brain magnetic resonance imaging, rebound effect, adverse events. Results: In the Early Treatment group, only 3/23 patients (13%) experienced a clinical relapse and only 2 out of 13 (15%) patients showed brain Magnetic Resonance Imaging (MRI) activity at 3 months, while none developed MRI activity at 6 months after cyclophosphamide introduction. In the Late Treatment Group 12/22 patients (63%) had relapses during the washout period and 4/22 (40%) after the introduction of cyclophosphamide; MRI disease activity was shown in 5/9 (56%) at 3 months and in 5/14 (36%) at 6 months after cyclophosphamide introduction.
Conclusions and relevance: These data show that cyclophosphamide could be able to reduce disease reactivation after natalizumab, in particular with a short washout period after natalizumab discontinuation. It can be suggested that a short period (3-6 months) of cyclophosphamide monthly pulses could be used as “re-induction” treatment in patients discontinuing natalizumab.