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Abstract
Objective: We aimed to investigate the influence of natalizumab (NTZ) treatment on multiple sclerosis course in patients with and without spinal involvement.
Methods: Annualized relapse rate (ARR), disability progression and occurrence of new brain and spinal T2 lesions (N2TL) in 68 spinal (S-P) versus 68 non-spinal matched patients (NS-P) were retrospectively collected and compared between before (2 years) and after NTZ treatment using multivariate regression models.
Results: Mean duration of NTZ treatment was 31.3 ± 16.3 months in S-P and 32.1 ± 15.1 months in N-SP (p = 0.56). The mean ARR after NTZ treatment was similarly reduced in both S-P (0.07 ± 0.19) and N-SP (0.07 ± 0.16) (p < 0.001 for both). Disability progression after NTZ start was similarly low in S-P and NS-P. However, when compared to before NTZ start, disability progression was significantly reduced in S-P (p = 0.017), but not in NS-P (p = 0.68). This was largely mediated by a higher disability progression before NTZ start in S-P than N-SP. The risk of developing N2TL during NTZ was not different between S-P and NS-P (p = 0.10).
Conclusions: NTZ similarly reduced the occurrence of relapses and NT2L in S-P and NS-P, whereas the effect on disability progression was particularly evident in the presence of spinal involvement. NTZ appears to be a treatment of high efficacy in both S-P and NS-P.
Acknowledgements
The authors thank Orlando Petrini, PD, Ph.D, Pole Pharma Consulting, Breganzona, Switzerland, for writing assistance. C Zecca, MR Heldner and C Gobbi contributed equally to this work.
Declaration of interest
C Zecca received personal compensation from Teva, Merck Serono, Biogen Idec, Bayer Schering, Novartis for consultancy service. MR Heldner declares no conflict of interest. CP Kamm has received compensation for activities as a consultant/speaker from Genzyme, Teva, Novartis, Merck Serono, Biogen Idec, Bayer and the Swiss MS Society. GC Riccitelli, G Disanto, M Caporro, A Cianfoni, E Pravatà declare no conflicts of interest. C Gobbi received personal compensation from Teva, Merck Serono, Biogen Idec, Bayer Schering, Novartis, Genzyme for consultancy service and grants from the Swiss MS Society.