Switching From Tysabri to Tecfidera

1/6/2014

Q. What is your experience in switching patients from Tysabri to Tecfidera? How efficient is this in preventing relapses?

A. We do not have much experience yet with switching patients from Tysabri to Tecfidera. I suspect we will have the same problems that we have experienced with switching patients from Tysabri to other drugs. I advise following these simple rules for now:

Do not switch unless you must. The "must" reason is usually a high index JC virus antibody result (high values are either > 1 or> 1.5 by most MS specialists) at any time. After at least a year of monthly Tysabri infusions, discuss with your doctor the possibility of increasing the interval between infusions to 8 weeks. This is done in many centers and theoretically should decrease the risk of PML. Of course, you will still need to be monitored with regular MRI scans even with the increased interval between infusions
If you do switch to another drug, make sure you start the drug at the same time as your last Tysabri infusion or even before the last infusion for some drugs. The timing will depend on the drug you choose but generally you want to avoid wash out periods where you are off medication
Generally do not switch to another drug or class of drugs that you did not respond to adequately prior to starting Tysabri
Ask you MS specialist about obtaining a repeat MRI scan of the head with and without gadolinium 4 to 6 months after the last infusion of Tysabri. This will help detect early recurrent activity that requires the addition of steroids or another treatment.

Good luck
--Dr. Kinkel

18 Comments

Leena

1/6/2014 12:39:48 pm

It's outraging how when discussing starting Tysabri, most neurologists don't talk about not having (efficient) strategies to quit it, or they make it sounds soooo minimal. I think patients should be warned, especially when patients are women who are very likely to be attempting pregnancy in following years. I wish i was...

maria s constantinescu

1/27/2015 10:47:12 am

I am from Romania originally and have a phd from nyu. i do not know what all the hype is about ms in the first place. it is just another immunological disease.

Amy massey

1/28/2015 11:22:50 pm

Do you have ms. I'm a nurse and I have ms.lts painful, scary and its no picnic to have this disease

Tari

4/16/2016 02:48:02 am

100% agree

Megan

2/13/2015 11:30:24 pm

Maria- what is your point exactly. Your tone sounds dismissive. I do hope that was not your intent. I have a 2 year old and a 4 year old. I have had long periods of time when I couldn't even hold them. They've seen the ambulance come to get me when, out of nowhere, my legs wouldn't work. My aunt died from complications due to MS. Not unlike many auto immune diseases, it is a scary and debilitating, often painful, disease. And, like any scary health issue, it deserves hype.

matt wilch link

5/29/2015 04:25:18 am

maria why aren't you more considerate about such involuntary medical conditions that no one chose to acquire?

Pamela McGhee

11/2/2015 10:41:57 am

Maria from Romania,
MS is a disease that can cripple one horribly, prevent one from living a decent life, or kill, as it did my mother.
There are no completely effective treatments, and once a body or body part is crippled, that crippling can not be reversed.
I am from New York, and have an MBA from NYU.
I also have breast cancer, metastatic, stage 4. It is being controlled by Fulvestrant.
Cancer is a piece of cake compared to MS, WHICH IS MUCH WORSE.
I have had MS for over 40 years and have watched myself become slowly crippled. It affects bladder and bowels as well as arms and legs, hands and feet.......any body system.......

I think you are cold and unfeeling and/or know nothing about MS.
You have no empathy.

4/16/2016 02:57:24 am

Maria your ignorance is not needed for those who only want/need positivety during rough times

Fonda

5/31/2016 01:03:23 pm

Well you obviously don't know anything about the disease then if you don't know what the "hype" is about. I am sure you are making your school so proud.

Lisa

1/15/2017 03:46:27 pm

To Maria from Romania,
I had to read your post twice just to make sure I was really reading what you said.HOLY SMOKES. You don't understand all the"hype" is about MS, "just another autoimmune disease.": And you are going to practice medicine? Stay away from me!

Gloria

4/20/2017 05:43:00 am

My. Daughter has had MS 20yrs diagnosed. at age 20.been blind, some days can't walk or even get out of bed in and out of hospital. I don't know what kind of degree you have, but you know nothing about MS, it takes away ones freedom and independence it's a very cruel disease, God help them find a cure.

Marissa

3/12/2015 11:25:54 am

Hello. What are some patients' experiences with switching from Tysabri to Tecfidera? I have been on and of Tysabri for close to 7 years and the recent literature suggests that those who are JCV+ must come off Tysabri for increased of PML. I'm very nervous about coming off Tysabri. It has been a miracle drug for me.

Anthony

3/31/2015 08:56:39 pm

Tysabri has been a miracle drug for me too. My new doc just switched me to Tecfidera...no one would prewscribe me tysabri (since i moved arouned a lot and had many diff doctors)...so I had some symptoms (vision loss and foot drag) before starting the tecfidera. THe doc sai Tecfidera won't maqke me better, it'll just prevent me from getting worse...I don't like that.

Gregg

4/6/2015 01:17:24 pm

I'm also switching from Tysabri to Tecfidera. I've been on Tysabri for almost 9 years. Prior to my first infusion in October of 2006..I could barely walk, or see. I have intense burning in the extremities, and the fatigue was devastating. By my 2nd infusion....I had no symptoms...and haven't had any since. However with a JCV index of 3.4...my risk of PML is higher than most. My Doc has recommended Tecfidera. I'm terrified. I'm terrified of a relapse and I'm terrified of the side effects. Any advice, stories, or support would be appreciated. Even if you haven't switched... I'd be interested in your experiences with Tecfidera.

11/2/2015 02:13:08 pm

I've had 4 exacerbation since switching to tecfidera in March. I'm also going thru a divorce....I'm worse then when I got first diagnosed!

Meredith Higley

2/17/2016 11:37:28 am

Dr. Kinkel...So happy to see your name! Best doctor ever! I miss you!

OldMS

6/11/2016 11:04:35 pm

Hi all, am taking Tysabri for the past 11+ yrs. very true ms cannot b cured, but is settled with less symptoms. During this time of Tysabri had 2 severe relapses which were controlled with cytoxin chemo with high dosages. Which helped me recover from being disabled. Yes I m JCV +. Not towards high side. So after goin through all phases I still would go for Tysabri. As its only drug I my case with no side effects. Rest gylenia etc did come up with continued symptoms. My neurologist in Florida has really helped me with positive thinking and got me out in dark times. Thank u Dr W. S. Any questions will b happy to answer regd treatment phases etc

Brad D.

3/28/2018 01:05:14 pm

Greetings All! I have been on Tysabri for 8+ years, and now my Dr. wants me to consider an alternative. I have, and am choosing to go on Tecfidera. While I look forward to the conclusion of the Infusions, I am skeptical of my Dr. insisting that I have a 90-day "wash-out" period. My current Dr. is not the Dr. who diagnosed me and was not privy to my first (and only*) relapse, where I was hospitalized 6-7 weeks, and went through Plasmapharesis (sp?) after the steroids were having little to no positive effect/influence. I am more inclined to take a 30-day wash-out period, not 90. Does anyone else have a similar story about this proposed treatment plan? What do you do if your symptoms worsen during this "wash-out period?" Is there an alternative to going cold-turkey during this transition period?

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