Switching from Ocrevus to Tysabri

Here is My Question:
After much consideration, I have made the decision to switch from Ocrevus to Tysabri. The options I am weighing are to either go to Kesimpta or Tysabri. Since Kesimpta is similar to Ocrevus I have decided to go with Tysabri due to the decline (clinically) that I was seeing with Ocrevus.

Anyway, I have seen a lot of postings from people going from Ocrevus to Tysabri but not many the other way around. Is this a change that you see often?

Also, in reading about Tysabri, I am wary of a couple of things:

1)PML- Although my JCV level is relatively low, 0.34, I would be lying if this does not worry me.
2)I know that due to the PML risk, Tysabri is usually not a drug that one is on for many years; I am concerned about "AFTER TYSABRI," as I have read, even on this site, "there is an increased risk of relapsing, usually within 6 months of stopping Tysabri."

My MS has declined clinically in the last few years; going from walking normally to using a cane sometimes due to leg weakness, and also much more spasms and spasticity, but my MRIs have remained stable.

I guess my main concern is since I have been so “stable,” with minimal decline, is going on Tysabri “worth the risk” of both PML as well as relapsing after stopping.

Please let me know your thoughts on this.
Thanks!

Answer:
Those are a lot of good questions. First let me eliminate some misinformation included in your question about the use of Tysabri

1. Tysabri can be used for many years, and we have many people who have taken this medication for more than 10 years
2. The risk of PML is 20 times higher if your JCV index is > 1.5 compared to a JCV index < 0.9. This is a very low risk that can be managed

This being said, Tysabri is only effective for definite relapsing forms of MS; This is a form of MS generally confined to younger people (Less than 45). Someone with no MRI activity or relapses, like yourself, who is experiencing continued worsening of their disease is better characterized as secondary progressive MS. Tysabri is not effective for secondary progressive disease in the absence of relapses or MRI disease activity. There are no approved therapies for secondary progressive MS without relapses or MRI disease activity and we are encouraging people in this stage of the disease to participate in clinical trials of newer DMTs, such as the selective Bruton Tyrosine Kinase (BTK) inhibitors 

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego