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Bridging, switching or drug holidays – how to treat a patient who stops natalizumab?

Overview of attention for article published in Therapeutics and Clinical Risk Management, October 2013
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Mentioned by

twitter
3 tweeters

Citations

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31 Dimensions

Readers on

mendeley
72 Mendeley
Title
Bridging, switching or drug holidays – how to treat a patient who stops natalizumab?
Published in
Therapeutics and Clinical Risk Management, October 2013
DOI 10.2147/tcrm.s41552
Pubmed ID
Authors

Joachim Havla, Ingo Kleiter, Tania Kuempfel

Abstract

Natalizumab (NAT) was the first monoclonal antibody to be approved for the treatment of relapsing-remitting multiple sclerosis (RRMS). While pivotal and postmarketing studies have showed considerable and sustained efficacy of NAT in RRMS, the increasing incidence of therapy-associated progressive multifocal leukoencephalopathy (PML), a brain infection caused by the John Cunningham virus (JCV), is a risk associated with long-term therapy. The risk for therapy-associated PML is highest in so-called "triple risk" patients. Therefore, long-term NAT-treated, immunosuppressive-pretreated, and JCV antibody-positive patients often discontinue NAT therapy. However, until now, it is not known which treatment strategy should be followed after NAT cessation. Since disease activity returns to pretreatment levels, or even above, within 4-7 months from the last infusion of NAT, patients who stop NAT are at considerable risk of relapse and worsening of multiple sclerosis (MS)-related disability. Several strategies have been applied to prevent the recurrence of disease activity after discontinuation of NAT. Of these, bridging with intravenous methylprednisolone, and switching to glatiramer acetate or interferon beta (IFN-beta) do not seem to be effective enough. More promising results have been obtained in retrospective studies and case series with fingolimod (FTY), an alternative escalation therapy for RRMS, although some patients have showed a severe disease rebound after starting FTY treatment. The time interval between the discontinuation of NAT and the start of FTY might affect the recurrence of disease activity. Long-term data about the efficacy and safety of FTY treatment after cessation of NAT are urgently needed and should be further investigated. Prospective studies are warranted, to optimize treatment strategies for RRMS patients who discontinue NAT, especially because new therapies will be available in the very near future.

Twitter Demographics

Twitter Demographics

The data shown below were collected from the profiles of 3 tweeters who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 72 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Brazil 4 6%
Spain 2 3%
United Kingdom 1 1%
Unknown 65 90%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 14 19%
Researcher 10 14%
Other 9 13%
Student > Master 7 10%
Student > Doctoral Student 5 7%
Other 13 18%
Unknown 14 19%
Readers by discipline Count As %
Medicine and Dentistry 33 46%
Neuroscience 8 11%
Agricultural and Biological Sciences 3 4%
Nursing and Health Professions 2 3%
Economics, Econometrics and Finance 2 3%
Other 7 10%
Unknown 17 24%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 03 October 2013.
All research outputs
#14,762,521
of 22,725,280 outputs
Outputs from Therapeutics and Clinical Risk Management
#753
of 1,261 outputs
Outputs of similar age
#122,885
of 207,105 outputs
Outputs of similar age from Therapeutics and Clinical Risk Management
#7
of 16 outputs
Altmetric has tracked 22,725,280 research outputs across all sources so far. This one is in the 32nd percentile – i.e., 32% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,261 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.5. This one is in the 31st percentile – i.e., 31% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 207,105 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 38th percentile – i.e., 38% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 16 others from the same source and published within six weeks on either side of this one. This one is in the 18th percentile – i.e., 18% of its contemporaries scored the same or lower than it.