Natalizumab treatment in a patient with chronic inflammatory demyelinating polyneuropathy

Abstract

Objective: To study clinical and paraclinical effects of natalizumab in a patient with chronic inflammatory demyelinating polyneuropathy (CIDP).

Design: Case report.

Setting: Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany. Patient A patient with highly active CIDP who did not respond to standard therapies. Intervention Standard therapy then treatment with natalizumab (300 mg).

Main outcome measures: Clinical disability, magnetic resonance imaging, and saturation of the alpha(4) integrin on T lymphocytes.

Results: T cells expressing the alpha(4) integrin were found in the inflamed peripheral nerve. Natalizumab bound with high affinity to the alpha(4) integrin on T lymphocytes in our patient. However, the patient's clinical condition deteriorated and as seen on magnetic resonance imaging without any measurable effect after treatment with this antibody.

Conclusions: Although experimental evidence suggests that natalizumab could theoretically be effective in immune-mediated disorders of the peripheral nervous system, our patient with CIDP did not benefit from this therapeutic approach. Natalizumab cannot be recommended in CIDP at present and should only be explored in controlled clinical trials.