Changing Therapies May Benefit Patients With Active MS

Finally, the neurologist must remember that a change in treatment may require a washout period. If a patient will switch from natalizumab to fingolimod, teriflunomide, or dimethyl fumarate, a two- to three-month washout period is recommended. Switching from teriflunomide to other MS therapies may require a 3.5-month washout, but an accelerated elimination procedure may be used, said Dr. Montalban. To change from fingolimod to teriflunomide or natalizumab requires one to two months to allow lymphocytes to return to the normal range. For similar reasons, a neurologist may recommend a two- or three-month washout when a patient switches from fingolimod or natalizumab to alemtuzumab.

Switching a patient to or from interferon beta or glatiramer acetate, however, does not require a washout period, said Dr. Montalban. Likewise, no washout period is needed when moving a patient from dimethyl fumarate to alemtuzumab, natalizumab, or fingolimod.

—Erik Greb