Practical Clinical Guidelines for Natalizumab Treatment in Patients With Relapsing Multiple Sclerosis.
Shirley O'Leary, Helen T Brugger, Dale Wallentine and 7 others
PMID 37920108WHAT IT FOUND
For natalizumab-treated relapsing MS patients, infusion nurses should complete a preinfusion checklist, monitor for PML symptoms, infuse over 1 hour, and stop for hypersensitivity signs.
Key findings
01Before every natalizumab infusion, the nurse must confirm TOUCH authorization, check the patient has read and understood the medication guide, and ask three questions about new symptoms and immune-weakening conditions.
02If signs or symptoms suggestive of PML occur, withhold natalizumab, contact the prescriber immediately, and arrange MRI and lumbar puncture as soon as possible.
03Natalizumab should be infused over 1 hour, never as bolus or IV push, and not mixed with other medication; observe for 1 hour postinfusion for the first 12 infusions and stop promptly if hypersensitivity signs occur.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It is a narrative review, so it has no original methods or primary outcome. Much of the PML risk and assay information comes from Biogen-developed or Biogen-subsidized materials. Recommendations are presented as expert guidance and prescribing information, not tested in a new trial. It summarizes trials in adults with relapsing MS, so it does not show how natalizumab affects patients outside those studied.
Declared interests
The paper notes Biogen research and a Biogen codeveloped and subsidized anti-JCV antibody assay. No full author disclosure or funding statement is shown in the supplied text.
The easy way to misread this
Do not treat a negative anti-JCV antibody test as proof that PML cannot happen. The paper says negative patients still have risk and need periodic retesting.