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

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Abstract

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

A. D. Kukushkina

Interdistrict Department of Multiple Sclerosis (IDMS), Zhadkevich City Clinical Hospital

Author for correspondence.
Email: dr_kukushanna@mail.ru
ORCID iD: 0000-0001-9964-8103

Neurologist

Russian Federation, Moscow

M. V. Davydovskaya

Pirogov Russian National Research Medical University

Email: dr_kukushanna@mail.ru
ORCID iD: 0000-0002-8294-0893
Russian Federation, Moscow

N. V. Khachanova

Pirogov Russian National Research Medical University

Email: dr_kukushanna@mail.ru
ORCID iD: 0000-0002-4943-4630
Russian Federation, Moscow

E. V. Popova

Pirogov Russian National Research Medical University

Email: dr_kukushanna@mail.ru
ORCID iD: 0000-0003-2676-452X
Russian Federation, Moscow

E. V. Ponevezhskaya

Interdistrict Department of Multiple Sclerosis (IDMS), Zhadkevich City Clinical Hospital

Email: dr_kukushanna@mail.ru
ORCID iD: 0000-0002-3718-2608
Russian Federation, Moscow

E. V. Lysogorskaya

Interdistrict Department of Multiple Sclerosis (IDMS), Zhadkevich City Clinical Hospital

Email: dr_kukushanna@mail.ru
ORCID iD: 0000-0002-7253-4736
Russian Federation, Moscow

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2. Fig. 1. MRI of the brain in T2 mode from August 2023 (left) and February 2024 (right), axial sections. Pronounced negative dynamics in the form of the appearance of new foci, some of which have a confluent nature

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3. Fig. 2. MRI of the brain in T2 mode from August 2023 (left) and February 2024 (right), sagittal sections. Pronounced negative dynamics in the form of the appearance of new foci, some of which are confluent in nature

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4. Fig. 3. MRI of the brain in T1 mode with contrast from August 2023 (left) and February 2024 (right). Negative dynamics in the form of the appearance of foci with signs of activity (arrows)

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