Natalizumab treatment for multiple sclerosis: recommendations for patient selection and monitoring

Ludwig Kappos, David Bates, Hans Peter Hartung, Eva Havrdova, David Miller, Chris H. Polman, Mads Ravnborg, Stephen L. Hauser, Richard A. Rudick, Howard L. Weiner, Paul W. O'Connor, John King, Ernst Wilhelm Radue, Tarek Yousry, Eugene O. Major, David B. Clifford

Research output: Contribution to journalReview articlepeer-review

178 Scopus citations


Natalizumab is a new treatment option for patients with active relapsing-remitting multiple sclerosis. In phase III studies, natalizumab was highly effective and well tolerated; however, three cases of progressive multifocal leucoencephalopathy (PML) were identified (estimated incidence of one per 1000; 95% CI 0·2-2·8; mean treatment period 17·9 months). In this Review we summarise the current information on PML, the three confirmed cases of PML, and the results of an extensive safety assessment of all patients treated with natalizumab. On the basis of these reviews, we make recommendations for appropriate selection of candidates for natalizumab and pretreatment assessments. In addition, a three-step diagnostic and management algorithm was developed to monitor natalizumab-treated patients with multiple sclerosis for PML and other opportunistic infections. The algorithm includes strategies for clinical, MRI, and laboratory assessments. Maintaining clinical vigilance allows for early suspension of natalizumab in potential cases of PML, thereby increasing the opportunity for immune reconstitution, which may improve prognosis if PML is confirmed.

Original languageEnglish
Pages (from-to)431-441
Number of pages11
JournalLancet Neurology
Issue number5
StatePublished - May 2007


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