Switching therapy from natalizumab to fingolimod in relapsing-remitting multiple sclerosis: clinical and magnetic resonance imaging findings

Mult Scler. 2012 Nov;18(11):1640-3. doi: 10.1177/1352458512464282.


Clinical and/or neuroimaging evidence of disease reactivation has been described in multiple sclerosis (MS) patients after a break from natalizumab. Whether fingolimod might be a therapeutic option following natalizumab needs to be evaluated. Twenty-two relapsing remitting MS patients having JC virus antibodies (JCVAb+) in serum were shifted 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. In 20/22 patients, brain magnetic resonance imaging (MRI) was obtained within one month after therapy initiation. Disease reactivation was observed in 11/22 (50%) patients: clinical relapses in six patients (four patients within the first month of therapy) and MRI activity in a further five patients (three patients within the first month of therapy). Clinical and/or MRI signs suggestive of disease rebound were observed in three patients. Our data indicate that fingolimod does not exert clinical activity quickly enough to stop MS reactivation after a break from natalizumab.

MeSH terms

  • Adult
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Antibodies, Viral / blood
  • Disability Evaluation
  • Drug Administration Schedule
  • Drug Substitution*
  • Female
  • Fingolimod Hydrochloride
  • Humans
  • Immunologic Factors / administration & dosage*
  • JC Virus / immunology
  • Magnetic Resonance Imaging*
  • Male
  • Multiple Sclerosis, Relapsing-Remitting / diagnosis
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy*
  • Multiple Sclerosis, Relapsing-Remitting / immunology
  • Multiple Sclerosis, Relapsing-Remitting / virology
  • Natalizumab
  • Propylene Glycols / administration & dosage*
  • Sphingosine / administration & dosage
  • Sphingosine / analogs & derivatives*
  • Time Factors
  • Treatment Outcome


  • Antibodies, Monoclonal, Humanized
  • Antibodies, Viral
  • Immunologic Factors
  • Natalizumab
  • Propylene Glycols
  • Fingolimod Hydrochloride
  • Sphingosine