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Natalizumab (Tysabri)
โ ๏ธ Natalizumab has been associated with the development of Progressive Multifocal Leukoencephalopathy (PML) due to JC virus reactivation. Patients require careful risk assessment, counselling, and monitoring. Always check the BNF link here.
๐ About
- Monoclonal antibody against integrins.
- Highly effective in relapsingโremitting multiple sclerosis (RRMS).
- โ ๏ธ Restricted use due to PML risk.
โ๏ธ Action
- Blocks the adhesion molecule ฮฑ4-integrin.
- Prevents immune cell migration across the bloodโbrain barrier.
- โ CNS inflammation โ โ MS relapses and MRI lesion activity.
๐ Indications
- Relapsingโremitting multiple sclerosis (RRMS): reduces relapse rate by ~70%.
- May slow disability progression in aggressive MS.
๐ Interactions
- ๐ See full list in the BNF.
- Avoid use with other potent immunosuppressants (โ risk of infections, esp. PML).
โ ๏ธ Cautions
- JC virus seropositivity โ higher PML risk (consider regular antibody testing).
- Previous immunosuppressant therapy (โ infection risk).
- Requires monitoring with MRI and clinical surveillance.
โ Contraindications
- Current or past PML.
- Severe immunocompromised states.
- Hypersensitivity to natalizumab or excipients.
๐ฅ Side Effects
- ๐ง Progressive multifocal leukoencephalopathy (PML) โ rare but often fatal.
- ๐คข Infusion-related reactions (nausea, headache, urticaria).
- ๐ฆ Increased risk of infections.
- ๐งช Rare: hepatotoxicity, hypersensitivity reactions.
๐ Dose
- 300 mg IV infusion once monthly.
- Administered under specialist supervision in hospital setting.
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