Smokers run increased risk of developing anti-natalizumab antibodies

Mult Scler. 2014 Jul;20(8):1081-5. doi: 10.1177/1352458513515086. Epub 2013 Dec 5.


Background: Smoking may contribute to the induction of neutralizing antibodies to interferon β-1a.

Objective: In this study, we aimed to investigate the influence of smoking on the risk of developing antibodies to natalizumab, another biological drug in the treatment of multiple sclerosis.

Methods: This report is based on 1338 natalizumab-treated multiple sclerosis patients included in either of two Swedish case-control studies in which information on smoking habits was collected. Using logistic regression, patients with different smoking habits were compared regarding risk of developing anti-natalizumab antibodies, by calculating odds ratios with 95% confidence intervals.

Results: Compared with nonsmokers, the odds ratio of developing anti-natalizumab antibodies was 2.4 (95% CI 1.2-4.4) for patients who smoked at the time of screening, and a significant trend showed higher risk of developing antibodies with higher intensity of smoking. When smoking within two years prior to screening was considered, the odds ratio of developing anti-natalizumab antibodies was 2.7 (1.5-5.1).

Interpretations: The finding strengthens our hypothesis of the lungs as immune-reactive organs on irritation in relation to autoimmune responses, and may also be of clinical relevance since antibodies against natalizumab abrogate the therapeutic effect of the treatment.

Keywords: Multiple sclerosis; Tysabri; immunology; smoking.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antibodies, Neutralizing / blood*
  • Biomarkers / blood
  • Case-Control Studies
  • Female
  • Habits
  • Humans
  • Immunologic Factors / adverse effects
  • Immunologic Factors / immunology*
  • Logistic Models
  • Male
  • Multiple Sclerosis / blood
  • Multiple Sclerosis / diagnosis
  • Multiple Sclerosis / drug therapy*
  • Multiple Sclerosis / immunology
  • Multivariate Analysis
  • Natalizumab / adverse effects
  • Natalizumab / immunology*
  • Odds Ratio
  • Registries
  • Risk Factors
  • Smokers*
  • Smoking / adverse effects
  • Smoking / blood
  • Smoking / immunology*
  • Sweden
  • Time Factors
  • Treatment Outcome


  • Antibodies, Neutralizing
  • Biomarkers
  • Immunologic Factors
  • Natalizumab