Department of Neurology, Fondation Ophtalmologique A. de Rothschild, Paris, France.
Department of Medical Imaging, Fondation Ophtalmologique A. de Rothschild, Paris, France.
J Neurol Neurosurg Psychiatry. 2014 Sep;85(9):1038-40. doi: 10.1136/jnnp-2014-307591. Epub 2014 May 29.
To characterise recurrence of multiple sclerosis (MS) inflammatory activity during the year following natalizumab (NTZ) cessation.
Thirty-two patients with MS were included in a monocentric cohort study. Data were collected prospectively during and after NTZ, with serial clinical and MRI evaluations. The first relapse occurring after interrupting NTZ was the primary outcome measure. The numbers of gadolinium-enhancing lesions before, during and after NTZ treatment, were compared.
During the year following NTZ cessation, the cumulative probability of relapses was estimated at 52.9% and an unusually high MRI inflammation was noticed. It was defined by a number of gadolinium-enhancing lesions >5 and exceeding the gadolinium lesions existing before NTZ initiation. Rebound of MS activity after NTZ cessation was characterised by association of relapses and unusual MRI inflammation. Cumulative probability of rebound was estimated at 39% and mostly occurring between 3 months and 9months after interrupting NTZ. Risk of rebound appears related with a higher annualised relapse rate and a lower Expanded Disability Status Scale score before NTZ initiation. Rebound was associated with severe recurring relapses in 9% of the patients.
This study identifies rebound after NTZ cessation as an association of relapses and high MRI activity.
描述那他珠单抗（NTZ）停药后一年内多发性硬化症（MS）炎症活动的复发情况。
32 例 MS 患者纳入单中心队列研究。在 NTZ 治疗期间和停药后进行前瞻性数据收集，进行连续的临床和 MRI 评估。中断 NTZ 后首次复发是主要的观察终点。比较 NTZ 治疗前后钆增强病变的数量。
在 NTZ 停药后的一年内，预计复发的累积概率为 52.9%，并出现异常高的 MRI 炎症。其定义为钆增强病变数>5，超过 NTZ 开始前存在的钆增强病变。NTZ 停药后 MS 活动的反弹表现为复发和异常 MRI 炎症的联合。反弹的累积概率估计为 39%，主要发生在中断 NTZ 后 3 个月至 9 个月之间。反弹的风险似乎与 NTZ 开始前更高的年复发率和更低的扩展残疾状态评分（EDSS）相关。反弹与 9%的患者出现严重复发有关。
本研究将 NTZ 停药后的反弹定义为复发和高 MRI 活动的联合，这是一种 MS 炎症的复发情况。
