Natalizumab for multiple sclerosis: the dilemma of NOVA

Before natalizumab was approved for clinical use, management of aggressive multiple sclerosis was unsatisfactory and unspecific. Natalizumab, a monoclonal antibody to the α4β1 unit of the integrin receptor that inhibits leukocyte trafficking into the brain, has shown promise in the treatment of relapsing-remitting multiple sclerosis in phase 3 studies.1,2 Of note, natalizumab led to significant reductions in relapse occurrence, disability progression, and MRI outcomes, including new or newly enlarging T2 lesions, compared with placebo or interferon beta.