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January 01, 2018; 5 (1) ArticleOpen Access

Disease activity following pregnancy-related discontinuation of natalizumab in MS

Iris Kleerekooper, Zoé L.E. van Kempen, Cyra E. Leurs, Iris Dekker, Theo Rispens, Birgit I. Lissenberg-Witte, Caspar E.P. van Munster, Brigit A. de Jong, Bob W. van Oosten, Bernard M.J. Uitdehaag, Mike P. Wattjes and Joep Killestein
First published December 6, 2017, DOI: https://doi.org/10.1212/NXI.0000000000000424
Iris Kleerekooper
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Zoé L.E. van Kempen
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Cyra E. Leurs
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Iris Dekker
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Theo Rispens
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Birgit I. Lissenberg-Witte
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Caspar E.P. van Munster
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Brigit A. de Jong
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Bob W. van Oosten
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Bernard M.J. Uitdehaag
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Mike P. Wattjes
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Joep Killestein
From the Department of Neurology (I.K., Z.L.E.v.K., C.E.L., I.D., C.E.P.v.M., B.A.d.J., B.W.v.O., B.M.J.U., J.K.), Amsterdam Neuroscience, VUmc MS Center Amsterdam, VU University Medical Center; Department of Immunology (T.R.), Landsteiner Laboratory Sanquin Research, Amsterdam; Department of Epidemiology and Biostatistics (B.I.L.-W.), VU University Medical Center; and Department of Radiology & Nuclear Medicine (I.D., M.P.W.), VUmc MS Center, Amsterdam, The Netherlands.
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Citation
Disease activity following pregnancy-related discontinuation of natalizumab in MS
Iris Kleerekooper, Zoé L.E. van Kempen, Cyra E. Leurs, Iris Dekker, Theo Rispens, Birgit I. Lissenberg-Witte, Caspar E.P. van Munster, Brigit A. de Jong, Bob W. van Oosten, Bernard M.J. Uitdehaag, Mike P. Wattjes, Joep Killestein
Neurology - Neuroimmunology Neuroinflammation Jan 2018, 5 (1) e424; DOI: 10.1212/NXI.0000000000000424

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    Figure Clinical and radiologic disease activity and confirmed disability progression across the 3 groups defined by time to conception

    (A) Relapses refer to the total number of reported relapses; no patient experienced more than 2 relapses. (B) MRI activity refers to active T2 hyperintense and/or contrast-enhanced T1 hyperintense lesions on the first MRI after DMT restart compared with the last MRI before NTZ discontinuation. (C) Confirmed disability progression defined as an increase in the EDSS score of 1.5, 1.0, or 0.5 point at DMT restart compared with the EDSS score of 0, 0.5–5.5, or >5.5 before NTZ discontinuation, respectively. DMT = disease-modifying treatment; EDSS = Expanded Disability Status Scale; NTZ = natalizumab.

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