Q&A 75: Natalizumab to tolebrutinib switch

Question

I have several patients on natalizumab (Tysabri). I would like to know if you have had issues with paramagnetic rim lesions or slowly expanding lesions (but no active Gd lesions) while on natalizumab. In other words, has natalizumab stopped the slowly expanding or paramagnetic lesions, or is this too difficult to control due to smouldering MS?

I have several patients on natalizumab who are continuing to progress. What do you typically do when people on natalizumab continue to progress without Gd-enhancing lesions? Do you keep these patients on therapy if they are showing PRLs and SELs?

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Prof G’s answer

Another series of questions from a healthcare professional which is very flattering to me.

Q1: Does natalizumab stop the slowly expanding or paramagnetic lesions, or is this too difficult to control due to smouldering MS?

Q2: What do you typically do when people on natalizumab continue to progress without Gd-enhancing lesions? Do you keep these patients on therapy if they are showing PRLs and SELs?

These are the billion-dollar questions that keep many researchers and pharmaceutical companies busy. The fundamental issue here is what we do about smouldering MS…