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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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3 X users

Citations

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31 Dimensions

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75 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 Kümpfel

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.

X Demographics

X Demographics

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 75 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Brazil 4 5%
Spain 2 3%
United Kingdom 1 1%
Unknown 68 91%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 15 20%
Researcher 11 15%
Other 9 12%
Student > Master 7 9%
Student > Doctoral Student 5 7%
Other 14 19%
Unknown 14 19%
Readers by discipline Count As %
Medicine and Dentistry 34 45%
Neuroscience 8 11%
Agricultural and Biological Sciences 4 5%
Social Sciences 3 4%
Nursing and Health Professions 2 3%
Other 7 9%
Unknown 17 23%
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
#16,721,717
of 25,374,647 outputs
Outputs from Therapeutics and Clinical Risk Management
#810
of 1,323 outputs
Outputs of similar age
#133,236
of 219,852 outputs
Outputs of similar age from Therapeutics and Clinical Risk Management
#6
of 14 outputs
Altmetric has tracked 25,374,647 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 1,323 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.6. This one is in the 30th percentile – i.e., 30% 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 219,852 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 37th percentile – i.e., 37% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 14 others from the same source and published within six weeks on either side of this one. This one is in the 7th percentile – i.e., 7% of its contemporaries scored the same or lower than it.