Fourteen years of experience in natalizumab infusion at a neuroimmunology service in the city of Pernambuco, Brazil

Address for correspondence: Lidiane Alves de Macedo Souza (email: [e-mail]).

Abstract

Background: Natalizumab (NTZ) is an effective therapy for the treatment of relapsing-remitting multiple sclerosis (RRMS), consisting of a recombinant humanized monoclonal antibody directed to the α4 subunit of integrins, launched in the market in 2005. Hospital da Restauração (HR), in the city of Recife, state of Pernambuco, Brazil, is a reference in the treatment of MS, and NTZ infusions began in 2009.

Objective: To retrospectively evaluate the 14-year experience in NTZ infusion in HR, in terms of demographic aspects, time until diagnosis, disease classification, time of medication use, previous use of immunosuppressants, and John Cunningham virus (JCV) status.

Methods: In total, 146 patients were exposed to the medication from 2009 to December 2023, 44 of whom were excluded due to loss to follow-up, resulting in a sample of 102 patients. The research was carried out through the evaluation of medical records and face-to-face interviews.

Results: The medication was being used by 71.5% of the affected patients. Treatment was discontinued in 28.43%; 0.98% developed progressive multifocal leukoencephalopathy, 3.92% died, 4.90% abandoned the treatment, 5.88 had a change of address, and in 11.76% the medication was suspended: in 9.98%, due to therapeutic failure, and 1.96%, per irregular use. Of the sample, 72.6% were female, 51.96% were of mixed race, 90.1% were classified as having RRMS, 6.86% had secondarily progressive MS, and 3.92% had primarily progressive MS with activity. The time until diagnosis was shorter than 6 months in 22.54%, from 6 to 12 months in 23.52%, from 12 to 24 months in 12.74%, longer than 24 months in 17.64%, and, for 23.52% there was no information. In total, 3.92% of the patients had previously used immunosuppressants. Of the sample, 38.3% had been using the medication for fewer than 2 years, 16.43%, between 2 and 4 years, and 45.5%, for more than 4 years. The rate of JCV positivity was of 34.24%.

Conclusion: Natalizumab is frequently used in HR, mainly in female patients and in those with RRMS. During treatment, surveillance is important for the early detection of complications.

 

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Publikationsverlauf

Artikel online veröffentlicht:
02. Oktober 2024