Here is My Question:
If Tysabri is working... does it stop inflammation? If I were to go off Tysabri would the inflammation process start up again? I have been on Tysabri for 8 years without any active lesions or signs of inflammation. Some doctors say that if there is no inflammation then the MS has transitioned to progressive - no inflammation. Isnt and that what Tysabri is suppose to do is to stop progression; hence inflammation? Thank you in advance for answering my questions.
Tysabri works by making more difficult for migration of the immune system from the periphery into the brain and spinal cord. This is likely why it works so well in reducing new relapses of multiple sclerosis, new lesion formation on the MRI, and mitigates disease progression. I would be careful not to say that is "stops" progression. In fact, the ASCEND study (Tysabri in secondary progressive multiple sclerosis) did not show it is better than placebo during this phase of the disease. The progressive phase of multiple sclerosis, in part, is independent of inflammation. This is an area of research where we need to learn more and develop other therapies targeted to the degenerative phase.
I would also add that since tysabri works so well, I wouldn't read too much into your experience of disease stability and coming to the conclusion that you must be in a progressive phase. Progression is measured clinically with objective metrics such as walking speed, cognitive testing, hand dexterity tests, strength, etc.
To answer your first question, the RESTORE study noted that there is roughly a 50% chance of having recurrence of disease activity after stopping tysabri. I have seen cases of this that can be quite disabling. When ever I contemplate taking a patient off tysabri, I get them on a bridging medication to lessen the chances of rebound inflammation. There is evidence that rituximab and gilenya can help in this regard. I have found good results with rituxan and tecfidera in getting patients off tysabri safely.
A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente
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