Having always been a strong advocate of Tysabri (Natalizumab) as an effective MS therapy, I was surprised (not in a nice way) to find that if I ever stop it, there is a danger of bad rebound relapses. I first read about this in the context of doctors putting people straight onto Gilenya (Fingolimod) to try and stop the rebound relapses. It doesn’t work unfortunately - I’ve copied the relevant bit of a smallish study done at Barts, below.
I think I personally would still have gone on Tysabri, but I would have preferred to make an informed choice. To anyone who I have expounded the benefits of Tysabri, I apologise.
Objective: To evaluate fingolimod as therapeutic option following natalizumab.
Methods: Twenty-two relapsing remitting MSers having JC virus antibodies (JCVAb+) in serum were switched from natalizumab to fingolimod after a three-month washout period. Neurological evaluation with the Expanded Disability Status Scale (EDSS) was performed monthly for a mean follow-up period of nine months.
Results: In 20/22 MSers, MRI was obtained within one month after therapy initiation. Disease reactivation was observed in 11/22 (50%) MSers: clinical relapses in six MSers (four MSers within the first month of therapy) and MRI activity in a further five MSers (three MSers within the first month of therapy). Clinical and/or MRI signs suggestive of disease rebound were observed in three MSers.
Conclusions: Our data indicate that fingolimod does not exert clinical activity quickly enough to stop MS reactivation after a break from natalizumab.