Effect of the natalizumab treatment on cererospinal fluid measures in multiple sclerosis: a longitudinal study. (P5.351)

Objective: To examine the effect of natalizumab on basic inflammatory cerebrospinal fluid measures over follow-up. Background: There is a lack of knowledge about evolution of cerebrospinal fluid (CSF) markers in multiple sclerosis (MS) patients on natalizumab treatment. Design/Methods: From the 388 patients screened for eligibility, 77 subjects (65% females; age 33.9; disease duration 11.5 years; median of Expanded Disability Status Scale 3.5) had ≥2 CSF examinations and were included in the study. Lumbar punctures were performed ≤6 months before and ≥12 months after natalizumab initiation. CSF samples with blood contamination (≥50 erytrocytes/mm 3 ) or high dose steroid treatment preceeding lumbar puncture ( Results: On average, before natalizumab initiation patients had greater number of CSF leukocytes (p=3×10 −12 ), higher level of total CSF protein (p=0.0004), CSF albumine (p=4×10−5), Albumin quotient (p=3×10−6), IgG quotient (p=6×10−12), IgM quotient (p=0.0008), IgG index (p=2×10 −9 ), IgG fraction (p=7×10 −6 ) and IgM fraction (p=0.007) than during the natalizumab treatment. After natalizumab initiation we also found a greater proportion of patients without oligo-clonal bands positivity (99% versus 88%; p=0.009). Patients with shorter disease duration had greater number of CSF leukocytes at baseline (R=−0.45; p=0.00005), greater decrease of CSF leukocytes (R=−0.49, p=0.00002) and greater decrease of IgG quotient (R=0.28, p=0.013) over follow-up. We did not find association between natalizumab treatment duration and evolution of CSF measures over follow-up. Conclusions: Natalizumab treatment in MS patients was associated with a significant reduction of spectrum of basic CSF inflammatory markers, which supports its important anti-inflammatory properties. Disclosure: Dr. Benova has received personal compensation for travel and conference fees from Novartis and Sanofi Genzyme. Dr. Andelova has nothing to disclose. Dr. Kadrnozkova has nothing to disclose. Dr. Havrdova has received personal compensation for activities with Biogen, Merck Serono, Novartis, Sanofi-Genzyme, and Teva as an speaker. Dr. Havrdova has received research support from Biogen. Dr. Horakova has received personal compensation for activities with Biogen Idec, Novartis, Merck, Bayer, Sanofi Genzyme, and Teva as a speaker. Dr. Uher has received personal compensation for activities with Biogen, Novartis, Sanofi Genzyme and EMD Serono. Dr. Uher has received research support from Biogen.