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. 2022 Feb 23;8(1):20552173211070752.
doi: 10.1177/20552173211070752. eCollection 2022 Jan-Mar.

Extended Interval Dosing Natalizumab and impact on neuropsychological deficits in Relapsing-Remitting Multiple Sclerosis

Eileen J McManus  1 , Karen M Clark  1 , Christopher Frampton  2 , Jamie A B Macniven  1 , Jan Schepel  1
Affiliations

Extended Interval Dosing Natalizumab and impact on neuropsychological deficits in Relapsing-Remitting Multiple Sclerosis

Eileen J McManus et al. Mult Scler J Exp Transl Clin. .

Abstract

Background: Cognitive impairment and neuropsychiatric symptoms are frequently reported in Relapsing-Remitting Multiple Sclerosis (RRMS). Natalizumab (NTZ) is usually administered on a 4-weekly Standard Interval Dosing (SID) schedule. However, Extended Interval Dosing (EID) at 6-8 weekly intervals has been proven non-inferior regarding relapse risk, with a lower risk of Progressive Multifocal Leukoencephalopathy (PML). The impact of EID NTZ on neuropsychological deficits in RRMS has not been studied. Objective: To determine if EID NTZ demonstrates an improvement in neuropsychological parameters in RRMS patients. Method: We performed a retrospective, observational analysis of 34 RRMS patients treated between August 2015-2017. Patients underwent baseline neuropsychological testing before commencing EID NTZ. A second evaluation was performed, on average 28 months after commencing treatment. Results: Z scores at the initial assessment showed baseline cognitive impairment in multiple domains. 14/20 Z-scores showed an improvement post-NTZ and 5/14 reached statistical significance; namely Trails A (visual attention/processing speed), Line-orientation (visual-spatial), Picture-naming (word finding), Digital-Span (attention, executive function and memory) and Story-recall (memory). The Hospital Anxiety and Depression Scale (HADS) data remained unchanged. Correlation matrix showed no association between HADS scores, the time between assessments and the changes in Z scores. Conclusion: This data suggests the efficacy of EID NTZ in improving cognitive impairment in RRMS. A prospective observational study is warranted.

Keywords: cognition; extended interval; multiple sclerosis; natalizumab; psychology.

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Figures

Figure 1.
Figure 1.
Flow chart showing the recrutiment process of patient from Neurology outpatients. DMTs = Disease Modifying Therapies.
Figure 2.
Figure 2.
Shoeing the changes in pre- and post- NTZ cognitive testing. *Z Scores with statistical significance p ≤ 0.05, **Z Scores with statistical significance p ≤ 0.01.
See this image and copyright information in PMC

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