Should I switch to Aubagio from Tysabri?

Here is My Question:
I have been taking Tysabri for over 5 years it worked GREAT. I felt normal again! Just tested positive for the JC virus. My New doctor (5th one) who is new at her job wants me to take Aubagio. I'm scared to death of a relapse, it does not sound as good or strong at Tysabri! I have been on Copaxone, and Rebif and neither worked. What do you recommend? Does she just want to try it because its new? Help please!! 

Answer:
I have reservations about transitioning from Tysabri to aubagio.  The ~50% risk of having rebound inflammation within the first 6 months off Tysabri requires attention.  In my opinion, aubagio is unlikely to provide the degree of protection in that critical period.  Gilenya, Tecfidera, and rituximab (or Ocrevus) would be better options for a transition.  From a PML standpoint, the risk with rituximab or ocrelizumab appear to be the lowest risk (although not zero) compared to Tecfidera and gilenya.

Eventually, Aubagio may be OK for your MS, but I do have reservations about using it to transition off Tysabri.  I suggest you discuss with your neurologist and share your concerns.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente

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