Antegren 2

[Guest guest]

Contd.. some cold water from Scotland..I have previously posted that

this doc disagrees with the basic MS hypothesis..

Natalizumab for Relapsing Multiple Sclerosis

[Correspondence]

Chaudhuri, Abhijit; Behan, O.

University of Glasgow; Glasgow G51 4TF, United Kingdom

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To the Editor: As participants in the original exploratory study,

[1] we did not find that treatment with anti-(alpha)(4)) integrin

antibody was of clinical benefit. and colleagues ( Jan. 2

issue) [2] report that monthly natalizumab infusions in patients

with multiple sclerosis significantly reduced relapse rates and

enhancing lesions on magnetic resonance imaging (MRI), but this

effect was not carried forward in the six months after treatment.

The treatment had no effect on the disability score (on the Kurtzke

Expanded Disability Status Scale). There was no evidence that long-

term natalizumab infusions modify the course of multiple sclerosis.

Epidemiologic studies have shown a biologic dissociation between

relapses and progressive disability once a score of 4 to 4.5 on the

Expanded Disability Status Scale is reached. [3] It may be argued

that all patients with multiple sclerosis should start receiving

natalizumab at the time of their first clinical presentation;

however, the effects of pregnancy in multiple sclerosis clearly

indicate that the progression of disability is independent of

clinical relapses. [4] Longitudinal MRI studies show that perivenous

inflammatory changes are associated with local alterations in the

blood-brain barrier and are not obligatory events in the evolution

of the plaques in multiple sclerosis. [5]

The results of immunotherapy trials in multiple sclerosis suggest

that although such treatments may reduce relapse rates, they do not

modify progressive loss of function. In a three-year follow-up of a

trial of treatment for acute optic neuritis, a benefit of

antiinflammatory treatment was not evident. [6] We are not convinced

that the effects of natalizumab on relapsing multiple sclerosis are

any exception.

Abhijit Chaudhuri, D.M., M.D.

O. Behan, D.Sc.

University of Glasgow; Glasgow G51 4TF, United Kingdom

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