{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:39:27Z","timestamp":1777937967574,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2026836"],"award-info":[{"award-number":["2026836"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2033165"],"award-info":[{"award-number":["2033165"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2040418"],"award-info":[{"award-number":["2040418"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000924","name":"Multiple Sclerosis Australia","doi-asserted-by":"publisher","award":["24-PGSR2-0129"],"award-info":[{"award-number":["24-PGSR2-0129"]}],"id":[{"id":"10.13039\/501100000924","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Following natalizumab failure, it is unknown whether switching to alternative high-efficacy therapies offers superior effectiveness over continuing natalizumab.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To compare different treatment strategies following natalizumab failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients suffering a relapse during natalizumab treatment with adequate follow-up were identified from the MSBase registry. Following natalizumab failure, natalizumab continuation was compared to switching to anti-CD20 therapies\/alemtuzumab\/lower-efficacy therapies and treatment discontinuation. The primary outcome was the risk of further relapses. Secondary outcomes included risk of subsequent magnetic resonance imaging (MRI) activity, confirmed disability worsening and disease-activity-free survival. Multivariable proportional hazards models compared outcomes during time-varying therapy exposures. Four sensitivity analyses were conducted with varied inclusion criteria and treatment failure definitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 1553 patients experiencing a relapse during natalizumab treatment, 1037 met the inclusion criteria. Following natalizumab failure, switch to anti-CD20 therapy was associated with a lower relapse risk (heart rate (HR)\u2009=\u20090.48, 95% confidence interval (CI)\u2009=\u20090.27\u20130.84) compared to continuing natalizumab; no differences were observed in MRI or disability outcomes. Treatment de-escalation or cessation was associated with increased relapse risk (HR\u2009=\u20091.46, 95% CI\u2009=\u20091.15\u20131.85; HR\u2009=\u20092.08, 95% CI\u2009=\u20091.22\u20133.55, respectively). We did not find evidence of a difference for switching to alemtuzumab. Sensitivity analyses replicated primary findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This exploratory study indicates that switching to anti-CD20 therapies following natalizumab failure is associated with a &gt;50% reduction in relapse risk. No differences were seen in secondary outcomes, despite consistent trends. Clinicians may consider anti-CD20 therapies following natalizumab failure, noting further research is needed to confirm differences in MRI and disability outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585251398682","type":"journal-article","created":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T07:32:56Z","timestamp":1766215976000},"page":"121-133","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Managing reactivation of multiple sclerosis during treatment with natalizumab"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3213-8390","authenticated-orcid":false,"given":"Nathaniel","family":"Lizak","sequence":"first","affiliation":[{"name":"Clinical Outcomes Research Unit (CORe), Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia"}]},{"given":"Sifat","family":"Sharmin","sequence":"additional","affiliation":[{"name":"Clinical Outcomes Research Unit (CORe), Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1915-0036","authenticated-orcid":false,"given":"Dana","family":"Hor\u00e1kov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic; General University Hospital, Prague, Czech Republic"}]},{"given":"Eva Kubala","family":"Havrdova","sequence":"additional","affiliation":[{"name":"Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic; General University Hospital, Prague, Czech Republic"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9159-3128","authenticated-orcid":false,"given":"Sara","family":"Eichau","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4278-7003","authenticated-orcid":false,"given":"Anneke","family":"van der Walt","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3940-8727","authenticated-orcid":false,"given":"Helmut","family":"Butzkueven","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia"}]},{"given":"Jeannette","family":"Lechner-Scott","sequence":"additional","affiliation":[{"name":"Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia; Hunter New England Health, John Hunter Hospital, Newcastle, NSW, Australia"}]},{"given":"Katherine","family":"Buzzard","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Box Hill Hospital, Melbourne, VIC, Australia; Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia"}]},{"given":"Olga","family":"Skibina","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Neurosciences, Box Hill Hospital, Melbourne, VIC, Australia; Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia"}]},{"given":"Oliver","family":"Gerlach","sequence":"additional","affiliation":[{"name":"Academic MS Center Zuyd, Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands; School for Mental Health and Neuroscience, Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands"}]},{"given":"Alexandre","family":"Prat","sequence":"additional","affiliation":[{"name":"CHUM MS Center and Universite de Montreal, Montreal, QC, Canada"}]},{"given":"Marc","family":"Girard","sequence":"additional","affiliation":[{"name":"CHUM MS Center and Universite de Montreal, Montreal, QC, Canada"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7231-1754","authenticated-orcid":false,"given":"Pierre","family":"Duquette","sequence":"additional","affiliation":[{"name":"CHUM MS Center and Universite de Montreal, Montreal, QC, Canada"}]},{"given":"Raed","family":"Alroughani","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6923-0846","authenticated-orcid":false,"given":"Francesco","family":"Patti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy"},{"name":"Multiple Sclerosis Unit, AOU Policlinico G Rodolico-San Marco, University of Catania, Catania, Italy"}]},{"given":"Francois","family":"Grand\u2019Maison","sequence":"additional","affiliation":[{"name":"Neuro Rive-Sud, Longueuil, QC, Canada"}]},{"given":"Maria Jos\u00e9","family":"S\u00e1","sequence":"additional","affiliation":[{"name":"Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal; Instituto de Investiga\u00e7\u00e3o, Inova\u00e7\u00e3o e Desenvolvimento Fernando Pessoa, Universidade Fernando Pessoa, Porto, Portugal; Faculdade de Ci\u00eancias da Sa\u00fade (FCS-UFP), Universidade Fernando Pessoa, Porto, Portugal; Rede de Investiga\u00e7\u00e3o em Sa\u00fade (RISE-UFP), Universidade Fernando Pessoa, Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8604-2054","authenticated-orcid":false,"given":"Eduardo","family":"Aguera-Morales","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University Hospital Reina Sofia, Cordoba, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain"}]},{"given":"Suzanne","family":"Hodgkinson","sequence":"additional","affiliation":[{"name":"Immune Tolerance Laboratory, Ingham Institute &amp; Department of Medicine, UNSW, Sydney, NSW, Australia"}]},{"given":"Pierre","family":"Grammond","sequence":"additional","affiliation":[{"name":"CISSS Chaudi\u00e8re-Appalache, Levis, QC, Canada"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6963-8892","authenticated-orcid":false,"given":"Jens","family":"Kuhle","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital &amp; University of Basel, Basel, Switzerland; Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland"}]},{"given":"Bassem","family":"Yamout","sequence":"additional","affiliation":[{"name":"Neurology Institute, Harley Street Medical Center, Abu Dhabi, United Arab Emirates"}]},{"given":"Samia J","family":"Khoury","sequence":"additional","affiliation":[{"name":"Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon"}]},{"given":"Serkan","family":"Ozakbas","sequence":"additional","affiliation":[{"name":"Izmir University of Economics, Medical Point Hospital, Izmir, Turkey"}]},{"given":"Tunde","family":"Csepany","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9834-4498","authenticated-orcid":false,"given":"Nevin","family":"John","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Department of Neurology, Monash Health, Clayton, MO, Australia"}]},{"given":"Guy","family":"Laureys","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital Ghent, Ghent, Belgium"}]},{"given":"Murat","family":"Terzi","sequence":"additional","affiliation":[{"name":"Medical Faculty, Mayis University, Samsun, Turkey"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3325-3760","authenticated-orcid":false,"given":"Maria Pia","family":"Amato","sequence":"additional","affiliation":[{"name":"Department NEUROFARBA, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy"}]},{"given":"Cavit","family":"Boz","sequence":"additional","affiliation":[{"name":"Department of Neurology, KTU Medical Faculty, Farabi Hospital, Trabzon, Turkey"}]},{"given":"Abdullah","family":"Al-Asmi","sequence":"additional","affiliation":[{"name":"College of Medicine &amp; Health Sciences and Sultan Qaboos University Hospital, Sultan Qaboos University, Al-Khodh, Oman"}]},{"given":"Elisabetta","family":"Cartechini","sequence":"additional","affiliation":[{"name":"Neurology Unit, P O Unico Macerata, Macerata, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9615-3797","authenticated-orcid":false,"given":"Riadh","family":"Gouider","sequence":"additional","affiliation":[{"name":"Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Tunis, Tunisia; 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