A 35-year-old woman with relapsing-remitting MS (2 relapses in 2 years, one lesion enhancing on MRI) is currently on interferon beta-1a. She has remained on this for 2 years with continued disease activity. Which high-efficacy DMT is most appropriate as an escalation option with a favorable safety profile?
- A Natalizumab (if JCV antibody negative) ✓
- B Fingolimod
- C Alemtuzumab
- D Mitoxantrone
Explanation
Natalizumab (anti-α4-integrin monoclonal antibody, AFFIRM trial) is a high-efficacy DMT that significantly reduces relapse rate (~68%) and lesion burden. In JCV-antibody-negative patients, the risk of progressive multifocal leukoencephalopathy (PML) — the major serious adverse event — is very low, making it a suitable high-efficacy escalation option. Alemtuzumab has greater efficacy but a higher and broader adverse event profile (autoimmune complications). Fingolimod is moderately high-efficacy but has cardiac and ocular monitoring requirements. Mitoxantrone has significant cardiotoxicity and cumulative dose limits.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.