• Alyssa A Toorop, Zoë Ygj van Lierop, Liza My Gelissen, Elske Hoitsma, Esther Mpe Zeinstra, Luuk C van Rooij, Caspar Ep van Munster, Anke Vennegoor, Jop P Mostert, Beatrijs Ha Wokke, Nynke F Kalkers, Erwin Lj Hoogervorst, Jeroen Jj van Eijk, Christiaan M Roosendaal, Jolijn J Kragt, Marijke Eurelings, Jessie van Genugten, Jessica Nielsen, Lgf Sinnige, Mark E Kloosterziel, Edo Pj Arnoldus, Gert W van Dijk, Willem H Bouvy, Mark Hj Wessels, Lynn Boonkamp, Eva Mm Strijbis, Bob W van Oosten, Brigit A De Jong, Birgit I Lissenberg-Witte, Frederik Barkhof, Bastiaan Moraal, Charlotte E Teunissen, Theo Rispens, Bernard Mj Uitdehaag, Joep Killestein, and Zoé LE van Kempen.
• MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands a.toorop@amsterdamumc.nl.
• J. Neurol. Neurosurg. Psychiatr. 2024 Apr 12; 95 (5): 392400392-400.

BackgroundExtended interval dosing (EID) of natalizumab is a promising strategy to optimise treatment in multiple sclerosis (MS). Personalised EID by therapeutic drug monitoring can enable further extension of treatment intervals.MethodsThe NEXT-MS trial is an investigator-initiated prospective phase IV non-randomised study. Adults with a diagnosis of relapsing-remitting MS who received ≥6 natalizumab infusions were included in three groups: personalised EID with a target drug trough concentration of 10 µg/mL (EID10), an exploratory group of personalised EID with a target of 5 µg/mL (EID5) and standard interval dosing (SID) of 4 weeks. The primary outcome is radiological disease activity (new/newly enlarged T2 lesions) comparing the EID10 group to a historical cohort of SID (HSID).ResultsResults of the first phase of the NEXT-MS trial are reported here (n=376) as the study will continue with an amended protocol. In the EID10 group (n=251), incidence rate of radiological activity was 10.0 per 1000 person-years, which was non-inferior to the HSID cohort (24.7 per 1000 person-years (n=87), incidence rate difference 14.7, 90% CI -4.5 to 34.0). Incidence rate of radiological activity was 10.0 per 1000 person-years in the EID5 group (n=65), and 47.0 per 1000 person-years in the SID group (n=60). Serum neurofilament light levels did not increase over time within the EID groups. There were no cases of progressive multifocal leukoencephalopathy.ConclusionsMS disease activity is adequately controlled with personalised natalizumab EID. Interval extension to a drug trough concentration of 5 µg/mL is likely a safe target to extend natalizumab treatment intervals >6 weeks.Trial Registration NumberNCT04225312.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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