Abstract
INTRODUCTION:
Natalizumab is a humanized monoclonal antibody prescribed in the treatment of multiple sclerosis, the most prevalent chronic and inflammatory disease of the central nervous system (CNS). NEDA (no evidence of disease activity) status is the goal of multiple sclerosis treatment.
METHODOLOGY:
The clinical records of 22 patients with multiple sclerosis, followed for a mean of 9.2 years (range: 1.9 -18.3 years) between 2000 and 2018 were analyzed. These patients received treatment with natalizumab in a high-complexity neurological outpatient clinic in Bogotá, Colombia.
RESULTS:
Eighteen patients (82%) reached NEDA status within a median time of six months. Seven patients (32%) tested positive for anti-JC virus antibodies. However, none of them developed progressive multifocal leukoencephalopathy. During the evaluation period, five patients (23%) presented new lesions and 17 patients (77%) had relapses before reaching NEDA status.
CONCLUSIONS:
This study gave an exploratory analysis of the characteristics of a series of patients with MS in the Colombian context. In the retrospective analysis, it was observed that more than 80% of the studied sample that received treatment with natalizumab, reached NEDA status. Despite the methodological limitations inherent to this type of study and sample size, it suggests that natalizumab could be an appropriate medication for the management of multiple sclerosis in Colombia.
References
Carretero Ares JL, Bowakim Dib W Acebes Rey JM. Actualización: esclerosis múltiple. Medifam. 2001;11(9):516-29.
Kornek B, Storch MK, Weissert R, Wallstroem E, Stefferl A, Olsson T, et al. Multiple sclerosis and chronic autoimmune encephalomyelitis. Am J Pathol. 2000;157(1):267-76.
Reich DS, Lucchinetti CF, Calabresi PA. Multiple sclerosis. N Engl J Med. 2018;378(2):169-80.
Sánchez JL, Aguirre C, Arcos-burgos OM, Jiménez I, Jiménez M, León F, et al. Prevalencia de la esclerosis múltiple en Colombia. Rev Neurol. 2000;31(12):1101-3.
Toro J, Sarmiento O, Díaz del Castillo A, Satizábal C, Ramírez J, Montenegro A, et al. Prevalence of multiple sclerosis in Bogotá, Colombia. Neuroepidemiology. 2007;28(1):33-8.
Toro J, Cárdenas S, Fernando Martínez C, Urrutia J, Díaz C. Multiple sclerosis in Colombia and other Latin American Countries. Mult Scler Relat Disord. 2013;2(2):80-9.
Ojeda E, Diaz-Cortes D, Rosales D, Duarte-Rey C, Anaya JM, Rojas-Villarraga A. Prevalence and clinical features of multiple sclerosis in Latin America. Clin Neurol Neurosurg. 2013;115(4):381-7.
Jiménez C, Zarco L, Castañeda C, Otálora M, Martínez A, Rosselli D. Estado actual de la esclerosis múltiple en Colombia. Acta Neurol Colomb. 2015;31(4):385-90.
O'Connor P, Goodman A, Kappos L, Lublin F, Polman C, Rudick RA, et al. Long-term safety and effectiveness of natalizumab redosing and treatment in the STRATA MS. Neurology. 2014;83(1):78-86.
Ho PR, Koendgen H, Campbell N, Haddock B, Richman S, Chang I. Risk of natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: a retrospective analysis of data from four clinical studies. Lancet Neurol. 2017;16(11):925-33.
Giovannoni G. Disease-modifying treatments for early and advanced multiple sclerosis. Curr Opin Neurol. 2018;31(3):233-43.
Adelman G, Rane SG, Villa KF. The cost burden of multiple sclerosis in the United States: a systematic review of the literature. J Med Econ. 2013;16(5):639-47.
Lasalvia P, Hernández F, Castañeda-Cardona C, Cuestas JA, Rosselli D. Cost-effectiveness of natalizumab compared with fingolimod for relapsing-remitting multiple sclerosis treatment in Colombia. Value Health Reg Issues. 2020;23:13-8.
Sánchez Múnera JL. Costos de la esclerosis múltiple en Colombia. Acta Neurol Colomb. 2012;28(1):1-3.
Plavina T, Subramanyam M, Bloomgren G, Richman S, Pace A, Lee S, et al. Anti-JC virus antibody levels in serum or plasma further define risk of natalizumab-associated progressive multifocal leukoencephalopathy. Ann Neurol. 2014;76(6):802-12.
Bloomgren G, Richman S, Hotermans C, Subramanyam M, Goelz S, Natarajan A, et al. Risk of natalizumab-associated progressive multifocal leukoencephalopathy. N Engl J Med. 2012;366(20):1870-80.
Polman CH, O'Connor PW, Havrdova E, Hutchinson M, Kappos L, Miller DH, et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354(9):899-910.
Rudick RA, Stuart WH, Calabresi PA, Confavreux C, Galetta SL, Radue E-W, et al. Natalizumab plus interferon beta-1a for relapsing multiple sclerosis. N Engl J Med. 2006;354(9):911-23.
The IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. Neurology. 1993;43(4):655-61.
Koch-Henriksen N, Sorensen PS. The Danish National Project of interferon-beta treatment in relapsing-remitting multiple sclerosis. Mult Scler. 2000;6(3):172-5.
Fingolimod for multiple sclerosis. Drug Ther Bull. 2012;50(2):18-20.
Warrender-Sparkes M, Spelman T, Izquierdo G, Trojano M, Lugaresi A, Grand'Maison F, et al. The effect of oral immunomodulatory therapy on treatment uptake and persistence in multiple sclerosis. Mult Scler. 2016;22(4):520-32.
Muñoz-Galindo IM, Alexander J, Calderón M, Elizabeth N, Téllez G, Orlando H, et al. Health care cost for multiple sclerosis: The case of a health insurer in Colombia. Value Health Reg Issues. 2018;17(13):14-20.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
