PT - JOURNAL ARTICLE AU - Giovannoni, Gavin AU - Marta, Monica AU - Davis, Angharad AU - Turner, Benjamin AU - Gnanapavan, Sharmilee AU - Schmierer, Klaus TI - Switching patients at high risk of PML from natalizumab to another disease-modifying therapy AID - 10.1136/practneurol-2015-001355 DP - 2016 Oct 01 TA - Practical Neurology PG - 389--393 VI - 16 IP - 5 4099 - http://pn.bmj.com/content/16/5/389.short 4100 - http://pn.bmj.com/content/16/5/389.full SO - Pract Neurol2016 Oct 01; 16 AB - There are several options for switching people with multiple sclerosis (MS) who are at high risk of developing progressive multifocal leukoencephalopathy (PML) from natalizumab to alemtuzumab. However, some of these have risks that need to be managed, for example, the risks of carrying over asymptomatic PML from natalizumab on to the new therapy, and the risk of rebound disease activity associated with a prolonged washout after starting natalizumab. We propose a pragmatic bridging strategy, using another disease-modifying therapy (DMT), to reduce the risk of switching from natalizumab to alemtuzumab. We also discuss the caveats and subtleties associated with sequencing DMTs in MS and the complex decision making involved.