{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T01:12:34Z","timestamp":1777770754447,"version":"3.51.4"},"reference-count":41,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T00:00:00Z","timestamp":1758412800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Background and Purpose<\/jats:bold>\n                    : Natalizumab (NTZ) is widely used for patients with highly active relapsing\u2013remitting multiple sclerosis (RRMS), but its discontinuation can lead to disease reactivation, significantly impacting Middle Eastern populations. This study aimed to assess the frequency of disease reactivation post\u2010NTZ discontinuation and identify possible demographic predictors.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods<\/jats:bold>\n                    : In this retrospective single\u2010center study, 171 patients with RRMS who received at least six consecutive NTZ infusions were analyzed. Clinical and radiological data were sourced from the AMIR registry. Binary and multivariate regression analyses were performed to identify factors associated with reactivation risk after 1 year, with a subset undergoing brain magnetic resonance imaging (MRI) segmentation and volumetric assessments.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    : Among 92 eligible patients, 16 (17%) showed disease reactivation. Prolonged washout periods (&gt;3 months) significantly increased reactivation risk (hazard ratio [HR] 1.015, 95% CI 1.007\u20131.022,\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0&lt;\u00a00.001), whereas higher Expanded Disability Status Scale (EDSS) scores correlated with a reduced risk (HR 0.492, 95% CI 0.280\u20130.866,\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0&lt;\u00a00.014). In the subset of cases that underwent brain MRI segmentation, higher NTZ infusion numbers and delayed bridging therapy initiation were linked to increased reactivation risk.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion<\/jats:bold>\n                    : NTZ discontinuation requires thorough clinical evaluation for bridging therapy, yet optimal strategies remain undefined. Early bridging therapy initiation may mitigate reactivation, highlighting the need for further research on predictive factors and disease\u2010modifying therapy efficacy.\n                  <\/jats:p>","DOI":"10.1002\/brb3.70904","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T06:41:02Z","timestamp":1758523262000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Radiological and Clinical Disease Reactivation in Multiple Sclerosis Patients After Cessation of Natalizumab (Tysabri)"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9992-0768","authenticated-orcid":false,"given":"Roba El","family":"Zibaoui","sequence":"first","affiliation":[{"name":"School of Medicine American University of Beirut  Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0476-0990","authenticated-orcid":false,"given":"Nabil K. El","family":"Ayoubi","sequence":"additional","affiliation":[{"name":"Department of Neurology American University of Beirut Medical Center  Beirut Lebanon"},{"name":"Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3198-6063","authenticated-orcid":false,"given":"Samia J.","family":"Khoury","sequence":"additional","affiliation":[{"name":"Department of Neurology American University of Beirut Medical Center  Beirut Lebanon"},{"name":"Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24651"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010021\u201002665\u20106"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517726657"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12487"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms18050940"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.7224\/1537\u20102073.2014\u2010113"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/14737167.2023.2184802"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsbmb.2020.105628"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.2217\/imt\u20102016\u20100113"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1004795"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000355"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000809"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458514533398"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012690"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458516641775"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40120\u2010015\u20100038\u20109"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13162"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102107"},{"issue":"17","key":"e_1_2_11_20_1","first-page":"e1926","article-title":"Multiple Sclerosis Relapses After Stopping Disease\u2010Modifying Therapy","volume":"99","author":"Naismith R. 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