Natalizumab

How it works

It binds alpha-4 integrin on leucocytes, preventing their adhesion to vascular endothelium and migration across the blood-brain barrier, thereby reducing inflammatory lesions in the central nervous system.

Prescribing in practice

• It carries a risk of progressive multifocal leukoencephalopathy, so check JC virus antibody status, stratify risk and monitor vigilantly for new neurological symptoms.
• Administer within a setting able to manage hypersensitivity and infusion reactions, and assess for persistent neutralising antibodies if efficacy wanes.
• Use only in line with the risk-management programme, with careful counselling before starting and at intervals during treatment.

Monitoring

Monitor JC virus antibody serology, MRI and clinical neurological status regularly to detect progressive multifocal leukoencephalopathy early.

Counselling the patient

• Report any new or worsening neurological symptoms, such as changes in vision, thinking or coordination, without delay.
• Attend all monitoring appointments and MRI scans as scheduled.
• Carry your alert documentation and tell other clinicians you are on this treatment.

Evidence & guidelines

Natalizumab reduces relapse rate and disability progression in highly active relapsing-remitting multiple sclerosis, with progressive multifocal leukoencephalopathy as a recognised serious risk noted in MHRA guidance.