WCN 2021 | Comparing exit strategies in natalizumab-responders at high risk for PML

Emanuele D’Amico, MD, University of Catania, Catania, Italy, shares the findings of a multicenter, real-world comparative study assessing the safety and efficacy of ocrelizumab, rituximab, and cladribine as natalizumab exit-strategies in patients with relapsing-remitting multiple sclerosis (MS) at high-risk for progressive multifocal leukoencephalopathy (PML). Annualized relapse rate and MRI activity were assessed as primary study endpoints. A total of 120 patients with stable disease (clinical and radiological stability) who switched from natalizumab due to high risk for PML were recruited. The data showed that patients who switched to ocrelizumab had a lower risk for annualized relapse rate compared to those who switched to cladribine or rituximab. The ocrelizumab group additionally had a lower risk for new MRI activity at 12 months. Regarding disability accrual, no differences were found across the three groups. The study concluded that all three drugs were well-tolerated and effective options as natalizumab exit strategies. This interview took place during the XXV World Congress of Neurology.