{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:38:03Z","timestamp":1790793483230,"version":"4.1.0"},"reference-count":29,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2017,8,21]],"date-time":"2017-08-21T00:00:00Z","timestamp":1503273600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Natalizumab is an effective treatment in relapsing-remitting multiple sclerosis (MS). Mainly because of the risk of progressive multifocal leukoencephalopathy (PML), a substantial proportion of John Cunningham (JC) virus\u2013positive patients switch to fingolimod. Previous reports show a clear benefit when the duration of a washout (WO) period of natalizumab is 0\u20133\u2009months in comparison to longer WO periods. However, there is no consensus regarding the optimal duration of a WO period under 3\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>We compared MS disease activity after different WO periods. In addition, we investigated several factors that possibly influence recurrence of disease activity, including serum natalizumab concentration and lymphocyte counts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>From a prospective observational cohort study of natalizumab-treated patients, we selected 52 patients who switched to fingolimod. We divided the patients in three groups (&lt;6\u2009weeks, 6\u20138\u2009weeks, &gt;8\u2009weeks WO). Serum natalizumab concentration and lymphocyte count were assessed during and after natalizumab treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Patients with a WO period of &gt;8\u2009weeks had a significant higher recurrence of disease activity (odds ratio, 6.8; 95% confidence interval, 1.4\u201332.8) compared to patients with a WO period of &lt;6\u2009weeks. Serum natalizumab concentration and lymphocyte count did not predict recurrence of disease activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation:<\/jats:title>\n                    <jats:p>A short WO period decreases the risk of recurrence of disease activity. The possible impact of a short WO period on the risk of carry-over PML in JC virus\u2013positive patients remains uncertain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1352458517726381","type":"journal-article","created":{"date-parts":[[2017,8,21]],"date-time":"2017-08-21T04:56:36Z","timestamp":1503291396000},"page":"1453-1460","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":21,"title":["Switching natalizumab to fingolimod within 6 weeks reduces recurrence of disease activity in MS patients"],"prefix":"10.1177","volume":"24","author":[{"given":"Cyra E","family":"Leurs","sequence":"first","affiliation":[{"name":"Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zo\u00e9 LE","family":"van Kempen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Dekker","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands \/ Department of Radiology and Nuclear Medicine, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisanne J","family":"Balk","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike P","family":"Wattjes","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo","family":"Rispens","sequence":"additional","affiliation":[{"name":"Department of Immunology, Landsteiner Laboratory Sanquin Research, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard MJ","family":"Uitdehaag","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joep","family":"Killestein","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neuroscience Amsterdam, VUmc MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,8,21]]},"reference":[{"key":"bibr1-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044397"},{"key":"bibr2-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107829"},{"key":"bibr3-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1177\/1352458511431073"},{"key":"bibr4-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22074"},{"key":"bibr5-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000355"},{"key":"bibr6-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2013.6240"},{"key":"bibr7-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001706"},{"key":"bibr8-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1177\/1352458513490551"},{"key":"bibr9-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000283"},{"key":"bibr10-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1177\/1352458512460604"},{"key":"bibr11-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1016\/j.ab.2011.01.001"},{"key":"bibr12-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1111\/cei.12261"},{"key":"bibr13-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1159\/000302687"},{"key":"bibr14-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000327671.91357.96"},{"key":"bibr15-1352458517726381","doi-asserted-by":"publisher","DOI":"10.5114\/ceji.2015.54599"},{"key":"bibr16-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000327609.57688.ea"},{"key":"bibr17-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.33.11.1444"},{"key":"bibr18-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000560"},{"key":"bibr19-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2015.106"},{"key":"bibr20-1352458517726381","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2015.157"},{"key":"bibr21-1352458517726381","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1136\/jnnp-2016-315106.113","volume":"87","author":"McGuigan 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