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December 2008

Natalizumab Use in Pediatric Multiple Sclerosis

Author Affiliations

Author Affiliations: Departments of Pediatrics and Pediatric Neurology (Drs P. Huppke, Stark, Zürcher, B. Huppke, and Gärtner) and Neuropathology (Dr Brück), Faculty of Medicine, Georg August University, Göttingen, Germany.

Arch Neurol. 2008;65(12):1655-1658. doi:10.1001/archneur.65.12.1655

Background  Natalizumab, a humanized monoclonal antibody raised against α4 integrins, is approved for treatment of active relapsing-remitting multiple sclerosis (RRMS) in adult patients.

Objective  To determine the safety, effectiveness, and tolerability of natalizumab use in pediatric patients with MS.

Design  Case report.

Setting  Center for MS in childhood and adolescents, Göttingen, Germany.

Patients  Three pediatric patients with RRMS having a poor response to other immunomodulatory therapies or having intolerable adverse effects.

Interventions  Natalizumab given every 4 weeks at a dosage of 3 to 5 mg/kg of body weight.

Main Outcome Measures  Cranial magnetic resonance (MR) imaging before treatment and every 6 months thereafter.

Results  During 24, 16, and 15 months of treatment, no further relapses occurred in the 3 pediatric patients; all reported significant improvement in their quality of life. Follow-up MR imaging showed no new T2-weighted lesions or gadolinium-enhancing lesions. No adverse events were seen when dosage was adjusted to body weight.

Conclusions  Natalizumab treatment was effective and well tolerated in our pediatric patients with RRMS who did not respond to initial immunomodulatory treatments. Therefore, it is a promising second-line therapy for pediatric patients with RRMS.