フィンゴリモドからナタリズマブへ疾患修飾薬変更後に疾患活動性が上昇した多発性硬化症の1例  [in Japanese] Increased disease activity in a case of multiple sclerosis after switching treatment from fingolimod to natalizumab  [in Japanese]

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Author(s)

    • 赤谷 律 Akatani Ritsu
    • 神戸大学大学院医学研究科脳神経内科学 Division of Neurology, Kobe University Graduate School of Medicine
    • 千原 典夫 Chihara Norio
    • 神戸大学大学院医学研究科脳神経内科学 Division of Neurology, Kobe University Graduate School of Medicine
    • 上田 健博 Ueda Takehiro
    • 神戸大学大学院医学研究科脳神経内科学 Division of Neurology, Kobe University Graduate School of Medicine
    • 松本 理器 Matsumoto Riki
    • 神戸大学大学院医学研究科脳神経内科学 Division of Neurology, Kobe University Graduate School of Medicine

Abstract

<p>42歳女性.37歳時に多発性硬化症(multiple sclerosis; MS)と診断.インターフェロンβ筋注薬の投与が開始され,再発頻度は4年間で2回であった.注射製剤への抵抗感が強く,41歳時にフィンゴリモドへ変更したが,リンパ球数低下あり約1ヶ月で中止し,ナタリズマブへ変更した.その後,11ヶ月で3回再発を繰り返し,T<sub>2</sub>病変数は12個から23個まで増加した.抗ナタリズマブ抗体が陽性であったためナタリズマブは中止した.疾患活動性の上昇には抗ナタリズマブ抗体による薬効の減弱やフィンゴリモド中止によるリバウンド現象の関与が疑われた.MS治療薬の変更に際し注意すべき事象の一つと考え報告する.</p>

<p>A 42-year-old woman diagnosed with multiple sclerosis (MS) at the age of 37 was initially treated with interferon-β IM. The frequency of clinical relapses was twice in 4 years. At the age of 41, due to difficulty in administering muscle injections, an oral medication fingolimod was started. However, it was discontinued after a month due to decreased lymphocyte count, following which natalizumab was administered. The number of relapses increased 3 times in eleven months, and the number of T<sub>2</sub> lesions on the MRI increased from 12 to 23. Natalizumab was discontinued because the test for the anti-natalizumab antibody was positive. It was suspected that both, the rebound syndrome caused by fingolimod cessation and the drug neutralization by anti-natalizumab antibodies, were associated with the exacerbation of disease activity. Thus, careful attention should be paid to potential occurrence of these events post switching between disease-modifying drugs for treating MS with high activity.</p>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 59(8), 536-540, 2019

    Societas Neurologica Japonica

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