II. Indications
- Multiple Sclerosis (relapsing)
- Moderate to severe Inflammatory Bowel Disease (refractory to TNF Inhibitors)
III. Contraindications
- Severe Infection
IV. Mechanism
V. Precautions
- See Monoclonal Antibody for preparation before first dose
VI. Dosing
- Infuse 300 mg IV over 1 hour every 4 weeks
- Discontinue if insignificant clinical response at 12 weeks or unable to taper off chronic Corticosteroids at 6 months
VII. Safety
- Unknown safety in pregnancy
- Unknown safety in Lactation
VIII. Adverse Effects
- Anaphylaxis
- Medication reaction
- Other serious adverse effects
- Elevated Liver Function Tests (Transaminitis, Hyperbilirubinemia)
- Progressive Multifocal Leukoencephalopathy (PML)
- Obtain John Cunningham Virus (JCV) Antibody every 6 months
- Discontinue Natalizumab if positive Antibody (increased PML risk)
- Discontinue (and MRI) if motor weakness, Incoordination or personality changes
IX. Efficacy
- Slower effects than with TNF Inhibitors
X. Resources
XI. References
- (2023) Biologics for Crohn's Disease, Presc Lett, #390826
- (2023) Drugs for Inflammatory Bowel Disease, Med Lett Drug Ther 65: 105-12