{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:24:49Z","timestamp":1783085089655,"version":"3.54.6"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aims to assess the efficacy of de\u2010escalating from natalizumab (NTZ) to cladribine (CLAD), dimethyl fumarate (DMF), fingolimod (FTY), ponesimod (PONE), siponimod (SIPO) and teriflunomide (TERI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>We analyzed data from 388 patients in the Austrian MS Treatment Registry who initiated NTZ treatment and remained on therapy for at least 3 months before switching to one of the moderately effective therapies within 1 year. Patients were required to remain on the de\u2010escalation therapy for at least 3 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over a mean treatment duration of 42\u2009months, the estimated ARR (annualized relapse rate) was 0.22 for highly effective therapy and 0.36 for de\u2010escalation therapies over 61\u2009months (<jats:italic>p<\/jats:italic>\u2009=\u20090.009). EDSS scores increased significantly from 2.8 to 3.1 during de\u2010escalation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Relapse probability during the treatment gap varied by interval: 14 patients (5.2%) in the &lt;\u20093 months group, 14 patients (15.7%) in the 3\u20136\u2009months group, and 13 patients (39.4%) in the 6\u201312\u2009months group (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Male sex, lower baseline ARR (prior to the initiation of hDMT) and during transition, older age, shorter disease duration, and lower EDSS scores at both baseline and post\u2010transition were significantly associated with a reduced risk of relapse and longer time to first relapse following de\u2010escalation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings reveal an increased risk of relapses and EDSS worsening following de\u2010escalation from NTZ. Additionally, relapse probability and EDSS progression were influenced by ARR during transition and EDSS scores at the end of the transition period.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.70282","type":"journal-article","created":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T02:49:59Z","timestamp":1751683799000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["De\u2010Escalation Treatment Strategies From Natalizumab in Patients With Relapsing Multiple Sclerosis in Austria"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8219-781X","authenticated-orcid":false,"given":"Michael","family":"Guger","sequence":"first","affiliation":[{"name":"Department of Neurology Pyhrn\u2010Eisenwurzen Hospital Steyr  Steyr Austria"},{"name":"Medical Faculty Johannes Kepler University Linz  Linz 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P\u00f6lten  St. P\u00f6lten Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Kalcher","sequence":"additional","affiliation":[{"name":"Hermesoft Data Management  Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erich","family":"Kvas","sequence":"additional","affiliation":[{"name":"Hermesoft Statistics  Graz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical University of Vienna  Vienna Austria"},{"name":"Comprehensive Center for Clinical Neurosciences &amp; Mental Health Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Austrian MS Treatment Registry 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