Highlights
- •Severe CNS inflammation after discontinuation of natalizumab and start of daclizumab.
- •Alemtuzumab was able to stabilize a devastating disease course.
- •Alemtuzumab represents a powerful drug after the use of daclizumab in patients with highly active multiple sclerosis.
Abstract
Natalizumab is highly effective in the treatment of relapsing multiple sclerosis patients.
Unfortunately, after stopping natalizumab, there is an increased risk of inflammation
in the central nervous system and relapses. Switching from natalizumab to an alternative
sufficient drug may prevent disease reactivation. Here we present a case of a patient
who experienced a dramatic course with severe central nervous system inflammation
after discontinuation of natalizumab and treatment initiation with daclizumab. During
a treatment of 36 days, 20 g intravenous methylprednisolone in total and ten courses
of plasmapheresis were not able to control the severe CNS inflammation. Alemtuzumab,
which targets the whole lymphocyte population, was able to stabilize the devastating
disease course in our case.
Keywords
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Article info
Publication history
Published online: March 29, 2018
Accepted:
March 28,
2018
Received in revised form:
March 20,
2018
Received:
September 20,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
