A case of rebound effect when switching from natalizumab to another highly effective drug in a patient with multiple sclerosis

Kukushkina A.D., Davydovskaya M.V., Khachanova N.V., Popova E.V., Ponevezhskaya E.V., Lysogorskaya E.V.

1) Interdistrict Department of Multiple Sclerosis (IDMS), Zhadkevich City Clinical Hospital, Moscow, Russia; 2) Pirogov Russian National Research Medical University, Moscow, Russia

Long-term use of natalizumab in the treatment of multiple sclerosis is associated with risks and requires caution. In cases of discontinuation of therapy, it is necessary to remember the possibility of rebound syndrome and determine the optimal timing of switching from one drug to another to minimize risks. However, it is important to focus on the risk of developing progressive multifocal leukoencephalopathy, especially in patients with a history of immunosuppressive therapy, with anti-JCV (John Cunningham virus) antibody index of more than 1.5 and receiving natalizumab therapy for more than 2 years. Therefore, assessing the risk-benefit ratio of using a particular drug to treat multiple sclerosis is a complex but crucial step in choosing a therapeutic strategy for a particular patient. We present a clinical case of a patient with the development of rebound syndrome after discontinuation of natalizumab therapy when switching to another highly effective drug.

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About the Authors

Corresponding author: Anna D. Kukushkina, Neurologist, Interdistrict Department of Multiple Sclerosis (IDMS), Zhadkevich City Clinical Hospital, Moscow, Russia; dr_kukushanna@mail.ru

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