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EAN 2022 | Updates on natalizumab and anti-CD20 antibodies for MS

The advancements in our understanding of the complex immune pathogenesis of multiple sclerosis (MS) have led to the development of over 20 disease-modifying therapies with various mechanisms of action. Massimo Filippi, MD, Vita-Salute San Raffaele University, Milan, Italy, reviews the latest advances in monoclonal antibodies for the treatment of MS. Natalizumab is a very well-known treatment that prevents the migration of leukocytes to the central nervous system by blocking alpha-integrins on the blood vessels membrane. Novel studies on natalizumab have shown that its administration can be spaced from every 4 weeks to 6 weeks while maintaining the same effect, and subcutaneous formulations have become available. The class of anti-CD20 monoclonal antibodies has also brought novelty into the MS space with the two recent antibodies: ocrelizumab and ofatumumab. This interview took place at the 2022 Congress of the European Academy of Neurology (EAN) in Vienna, Austria.

Transcript (edited for clarity)

The therapeutic armamentarium for MS has changed dramatically in the last 20 years or so. The most advanced therapeutic approaches are monoclonal antibodies, which has the advantage to be very targeted to a given target. To be very effective on the one side and to reduce the side effects on the other.

We have different monoclonal antibodies useful for the treatment of MS. I will review two of them, which is two classes of them...

The therapeutic armamentarium for MS has changed dramatically in the last 20 years or so. The most advanced therapeutic approaches are monoclonal antibodies, which has the advantage to be very targeted to a given target. To be very effective on the one side and to reduce the side effects on the other.

We have different monoclonal antibodies useful for the treatment of MS. I will review two of them, which is two classes of them. One, which is natalizumab, which prevents the move of lymphocytes from the periphery to the CNS, by blocking alpha-integrin on the blood vessel’s membrane. This is a very well known treatment. The new things about natalizumab is the fact that there are studies now showing that you can space the administration, from four weeks to six weeks. And having the same effect or the subcutaneous administration, instead of the infusion administration. The drug has been shown to be very effective since many years.

The other class is anti-CD20 monoclonal antibodies. We have several of them, the two most important and most recent are ocrelizumab on the one side, which is given every six months through infusion. And the very recent one is ofatumumab, which is a fully human monoclonal antibody, which is given subcutaneously every month. So both of them are very important in terms of, in this cases, depleting the B-cells and their effect on the immune cascade leading to tissue damaging multiple sclerosis. The main news in this era is the incoming of ofatumumab, as I said, which is a new fully human monoclonal antibody.

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Disclosures

Editor in Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Associate Editor of Radiology, and Associate Editor of Neurological Sciences;
Compensation for consulting services and/or speaking activities from Alexion, Almirall, Bayer, Biogen, BMS, Celgene, Chiesi Italia, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Roche, Sanofi, Takeda, and Teva Pharmaceutical Industries;
Research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Minsitry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA.