Real-world transition from uncontrolled disease to stability: Three-year Pre-post natalizumab comparison in relapsing multiple sclerosis
Multiple Sclerosis and Related Disorders, vol.110, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 110
- Publication Date: 2026
- Doi Number: 10.1016/j.msard.2026.107195
- Journal Name: Multiple Sclerosis and Related Disorders
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE
- Keywords: MRI, Multiple sclerosis, Natalizumab, Pregnancy, Real-world data
- Dokuz Eylül University Affiliated: Yes
Abstract
Background: Natalizumab is a highly effective therapy for relapsing multiple sclerosis (MS), yet few real-world studies have directly compared disease activity before and after treatment initiation within the same patients. Objective: To evaluate the real-world impact of natalizumab on relapse activity, disability, and MRI activity by comparing disease outcomes during the three years before and after treatment initiation. Methods: We retrospectively analyzed 246 patients who initiated natalizumab at a single centre. After excluding patients without baseline data (n = 38) or with insufficient follow-up or incomplete MRI data (n = 77), 131 patients were included in the final analysis. Annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS), and MRI activity were compared between the 36-month pre-treatment and 36-month on-treatment periods. Results: Natalizumab treatment was associated with a marked reduction in relapse activity. Mean ARR decreased from 0.69 in the pre-treatment period to 0.04 during the on-treatment period, and the proportion of patients with relapses declined from 88.5% to 8.4%. Disability remained overall stable during follow-up, with no significant difference between EDSS three years before treatment and EDSS three years after treatment. MRI activity decreased from 74.8% in the pre-treatment period to 9.2% during the on-treatment period, and 84.0% of patients achieved no evidence of disease activity (NEDA-3). Pregnancy-related observations were limited to a small descriptive subgroup. Conclusion: Over three years, natalizumab was associated with substantial suppression of relapse activity, stable disability, and reduced MRI activity compared with the pre-treatment period.