Neurology: Natalizumab (natalizumab), the treatment of drug-resistant focal epilepsy, how effective and safe

The main treatment for patients with epilepsy is antiepileptic drugs (ASD), which can balance the excitation and inhibition of neurons
.

Natalizumab is an anti-α4-integrin monoclonal antibody, approved for the treatment of multiple sclerosis
.

In this way, Jacqueline A.
French of New York University and others hypothesized that by reducing the BBB dysfunction caused by white blood cell-vascular interaction, natalizumab increases the threshold of seizures, thereby reducing the recurrence of epilepsy
.

Conversely, the reduction of seizures will reduce the neurogenic inflammation caused by the seizure itself, thereby breaking the cycle of BBB damage, neuroinflammation and seizures
.

Therefore, in the OPUS study, the effectiveness and safety of natalizumab as an adjuvant therapy for drug-resistant focal epilepsy were systematically explored
.

Participants who had ≥6 seizures during the 6-week baseline period were randomized to receive natalizumab 300 mg intravenously or placebo at a 1:1 ratio, once every 4 weeks for 24 weeks
.

Among the 32 and 34 participants in the natalizumab 300 mg group and the placebo group, 30 (94%) and 31 (91%) completed the placebo-controlled treatment period (one participant) Randomized to receive natalizumab, but was not injected due to intravenous complications)
.

The frequency of seizures of natalizumab relative to placebo is estimated to be -14.
4% (95% CI -46.
1% to 36.
1%, p = 0.
51)
.

The proportion of participants whose seizure frequency was reduced by ≥50% from baseline was 31.
3% with natalizumab and 17.
6% with placebo (the odds ratio was 2.
09, 95% CI was 0.
64-6.
85, P = 0.
22)
.

Twenty-four (75%) and 22 (65%) participants who received natalizumab and placebo reported adverse events (AEs)
.

The significance of this study is found: Although Ran did not reach the threshold to prove efficacy, but found no unexpected safety, it is necessary to further explore possible anti-inflammatory therapies to treat drug-resistant epilepsy
.

Original source:
French JA, Cole AJ, Faught E, et al.