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