那他珠单抗(Natalizumab)的副作用如何缓解？

Natalizumab works by inhibiting immune cell migration. Although its efficacy is significant, it is also accompanied by some potential side effects.

Main side effects of Natalizumab

1. Serious side effects (requiring immediate medical intervention)

(1) Progressive multifocal leukoencephalopathy (PML): It is the most dangerous and concerning side effect. PML is a rare, serious, and potentially fatal opportunistic brain infection caused by the JC virus.

(2) Other serious infections:

Herpes infection: may cause life-threatening encephalitis, meningitis, and acute retinal necrosis that may lead to blindness. Symptoms include sudden high fever, severe headache, vision loss, red and painful eyes.

Liver damage: There are cases of severe liver damage or even liver failure. Symptoms include yellowing of the skin or the whites of the eyes (jaundice), abnormally dark urine, severe fatigue, nausea and vomiting.

2. Common side effects (higher incidence)

In clinical studies of multiple sclerosis and Crohn's disease, the most common side effects (incidence ≥10%) include:

Headache, fatigue (asthenia), joint pain, infections such as urinary tract infection, upper and lower respiratory tract infections, gastroenteritis, nausea (especially in patients with Crohn's disease), as well as depression, rash, limb pain, etc.

The pictures are from public channels (such as the official website of the FDA, the official website of the original drug manufacturer, etc.) and are for reference only.

Natalizumab side effect relief

For different side effects, targeted relief and management measures should be taken.

1. Response to serious side effects

(1) Monitoring and management of PML

Detect JC virus antibodies before medication and regularly (such as every 6 months) during treatment, and evaluate the risks and benefits with your doctor.

Patients should pay close attention to any new or worsening neurological symptoms and notify their doctor immediately if they occur.

If PML is suspected, the doctor will immediately suspend the medication and conduct brain MRI and cerebrospinal fluid JC virus DNA testing to confirm the diagnosis. There is currently no specific treatment for PML, and early detection and discontinuation of drugs are the key to improving the prognosis.

(2) Treatment of serious infections

If you have fever, persistent cough, herpes (such as herpes zoster) or other signs of infection, you should seek medical treatment in time. Once a serious infection (such as herpetic encephalitis) is diagnosed, natalizumab needs to be stopped immediately and standard antiviral and other treatments started.

(3) Treatment of allergic reactions

Close observation during infusion. All infusions should be performed in medical facilities and observed for at least 1 hour after infusion (first 12 infusions). If a severe allergic reaction occurs, the infusion will be stopped immediately and emergency treatment such as anti-allergy treatment will be given. Patients who have experienced severe allergic reactions should not use it again.

2. Relief of common side effects

(1) Headache, joint pain: You can discuss with your doctor the use of over-the-counter analgesics (such as acetaminophen) to relieve symptoms.

(2) Fatigue: Ensure adequate rest, arrange activities reasonably, and eat a balanced diet.

(3) Minor infection: such as a common cold, you should drink more water, rest more, and treat it as directed by your doctor. If the infection worsens or persists, seek medical attention promptly.

(4) Nausea: Try eating small meals frequently and avoid greasy food. If severe, the doctor may prescribe antiemetic drugs.

Natalizumab (Natalizumab) Medication Precautions

1. Combination use is prohibited

(1) Patients with Crohn's disease: It is strictly prohibited to use it in combination with immunosuppressants such as tacrolimus, azathioprine, methotrexate, or TNF-α inhibitors (such as infliximab), which will greatly increase the risk of serious infection and PML.

(2). All patients: Usually should not be used in combination with other immunosuppressive therapies.

2. Standardized infusion operations

Drugs must be infused intravenously by professional medical staff for more than 1 hour and cannot be injected intravenously. The diluted solution must be used within 4 hours.

3. Maintain open communication with the doctor

Before starting treatment, inform the doctor of all medical history, especially immune system status, infection history, liver history and allergy history. During treatment, promptly report any new or worsening symptoms.