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Extended interval dosing strategies in multiple sclerosis: insights from natalizumab and ocrelizumab trials

Zid, Yasmin and Robertson, Neil P. ORCID: 2024. Extended interval dosing strategies in multiple sclerosis: insights from natalizumab and ocrelizumab trials. Journal of Neurology 271 (4) , pp. 2141-2143. 10.1007/s00415-024-12273-9

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Recent advances in the treatment of relapsing multiple sclerosis (RRMS) have seen the emergence of a wide range of high efficacy disease-modifying therapies (DMTs) including natalizumab and ocrelizumab, which are now well embedded in routine clinical practice. However, despite their undoubted efficacy in reducing disease activity and relapse rates, challenges persist regarding dosing regimens and potential adverse effects. Natalizumab, administered intravenously every 4 weeks, carries a small but significant risk of progressive multifocal leukoencephalopathy (PML) with risk factors including prolonged dosing, a high JC index or previous chemotherapy. Ocrelizumab, administered every 6 months, has raised long-term concerns concerning B cell repopulation dynamics, acquired immunodeficiency, and vaccine efficacy. It is thought that some of these risks could be modified by adaptation of existing dosing regimens without sacrificing efficacy and have become the focus of recent clinical trials. This month's journal club explores some of the recent studies in this field and discusses implications for clinical practice. The first paper compares the effects of extended interval dosing (EID), with standard interval dosing (SID) on brain atrophy. The second paper addresses similar questions about ocrelizumab and its effects on B-cell repopulation. The third paper, the NOVA trial, assesses the safety and efficacy of switching natalizumab dosing frequency from once every four weeks to once every six weeks in patients with relapsing multiple sclerosis (RRMS). The final paper from the NEXT-MS trial provides insights into tailoring treatment approaches based on individual patient responses, thereby further enhancing treatment outcomes.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: License information from Publisher: LICENSE 1: URL:, Type: open-access
Publisher: Springer
ISSN: 0340-5354
Date of First Compliant Deposit: 28 March 2024
Date of Acceptance: 22 February 2024
Last Modified: 04 Apr 2024 12:23

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