DX39
Monthly 3T MRI in MS Patients Switched from Natalizumab to Teriflunomide in a Controlled, Prospective Study

Thursday, May 25, 2017
B2 (New Orleans Convention Center)
Keith R Edwards, MD , MS Center of Northeastern New York, Latham, NY
Stanley Cohan, MD, PhD , Providence Multiple Sclerosis Center, Portland, OR
Lore Garten, MD, Ph. D. , MS Center of Northeastern New York, Latham, NY
James Thomas, M.D. , Radiology, Community Care Physicians, P.C., Latham, NY
Kyle E Smoot, MD , Providence Multiple Sclerosis Center, Portland, OR
Kiren Kresa-Reahl, MD , Providence Multiple Sclerosis Center, Portland, OR
Judy O'Connor, BSW, CCRC , MS Center of Northeastern New York, Latham, NY
Tiffany Gervasi, Clinical Research Coordinator , Providence Multiple Sclerosis Center, Portland, OR
Chiayi Chen, Ph.D. , Providence Multiple Sclerosis Center, Portland, OR
Jessica Siuta, BSMT, ASCP, Clinical Research Coordinator , MS Center of Northeastern New York, Latham, NY
Vineetha Kamath, BS , MS Center of Northeastern New York, Latham, NY
Vineetha Kamath, BS , MS Center of Northeastern New York, Latham, NY



Background: Natalizumab (NTZ) has the risk of causing progressive multifocal leukoencephalopathy (PML) in MS patients after extended use and with detectable anti-JCV-antibodies. . There is a need for alternative disease modifying treatment (DMT) that would be safe and effective to prevent recurrence of MS exacerbations upon discontinuation of NTZ without further risk of PML

Objectives: To explore the safety and efficacy of teriflunomide in patients switching from NTZ to teriflunomide in MS patients at risk for PML with monthly 3T MRI monitoring. 

Methods: Patients with RMS must have received 12 or more NTZ treatments and be anti-JCV-ab positive without prior immunosuppressive therapy.   Patients had to be free of clinical relapses during prior 12 months of NTZ treatment.   Patients began teriflunomide 14 mg once daily within 4 weeks after last dose of NTZ.   3T brain MRI, EDSS, laboratory tests, interim history and physical examination were performed at baseline and monthly for 6 months.

Results: There were 55 patients enrolled.  Mean age was 47.  Seventy-six percent were female.  The mean EDSS at baseline was 3.05 (SD 1.37); at 6 months, 2.79 (SD 1.26) an improvement.  The mean number of NTZ treatments prior to treatment with teriflunomide was 42 (SD 25.82). MRI results showed 42 patients stable in all parameters from baseline to month 6.  Of the patients with new MRI lesions, only 5 had symptoms.   Eleven events occurred in 5 patients with new or enlarging T2 hyperintensities. Contrast enhancing lesions occurred in 9 patients from month 3 to 6 but only three required change of DMT.

Conclusions: These results show that, in the majority of patients treated, teriflunomide may be a rational choice for long term safety and efficacy.  Early initiation of teriflunomide after discontinuation NTZ, fewer than 4 weeks, appears to be important in preventing recurrance of MRI and clinical activity.  No MRI 'rebound' activity was observed.