I'm antibody positive after three years on Tysabri...what should I do?

Question:
I started Tysabri about 3 yrs ago. I would get blood test about every 6 months and they would be negative, until NOW. They say it's positive. What should I do now. I don't want to die.

Answer:
If you turn antibody positive after 3 years of Tysabri infusions, you have a number of options:

Option 1: continue on Tysabri. This is a good choice if you previously tried 2 or more prior therapies of different classes that were not effective or tolerated, Tysabri controlled your disease completely over the past 3 years, and you have a high risk of worsening after stopping Tysabri. If these criteria are met and your JC Virus antibody index is less than 1.5, you can continue on Tysabri given every 8 weeks with monitoring MRI (for early detection of PML) every 4 months. If your JCV index is > 1.5, continuing Tysabri is still an option but most MS specialists would recommend an alternative treatment. Lemtrada and Rituximab (soon to be Ocrelizumab) are options for highly active treatments that can reduce the risk of severe relapses after stopping Tysabri.

Option 2: switch to another therapy: If Tysabri is the only DMT you have taken or you only took platform therapies before starting tysabri (either interferons or copaxone) and you do not have significant risk factors for severe disease, then it is reasonable to switch to an oral therapy at this time. These options include Aubagio, Tecfidera and Gilenya. 

Good luck. Discuss these choices with your MS specialist to help you make a good decision
Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Director of Hillcrest Neurology
Professor of Clinical Neurosciences
University of California San Diego