Natalizumab reduces visual loss in patients with relapsing multiple sclerosis

L. J. Balcer, S. L. Galetta, P. A. Calabresi, C. Confavreux, G. Giovannoni, E. Havrdova, M. Hutchinson, L. Kappos, F. D. Lublin, D. H. Miller, P. W. O'Connor, J. T. Phillips, C. H. Polman, E. W. Radue, R. A. Rudick, W. H. Stuart, A. Wajgt, B. Weinstock-Guttman, D. R. Wynn, F. LynnM. A. Panzara

Research output: Contribution to journalArticle


OBJECTIVE: To examine the effects of natalizumab on low-contrast letter acuity as a prespecified tertiary endpoint in two randomized clinical trials and to evaluate the usefulness of low-contrast letter acuity testing as a candidate test of visual function in multiple sclerosis (MS). METHODS: AFFIRM and SENTINEL were randomized, double-blind, placebo-controlled, multicenter, phase 3 clinical trials of natalizumab in relapsing MS. Natalizumab was evaluated as monotherapy in AFFIRM and as add-on to interferon beta-1a in SENTINEL. Vision testing was performed at 100% contrast (visual acuity) and low-contrast (2.5% and 1.25%). RESULTS: The risk of clinically significant visual loss (predefined as a two-line worsening of acuity sustained over 12 weeks) at the lowest contrast level (1.25%) was reduced in the natalizumab treatment arms by 35% in AFFIRM (hazard ratio = 0.65; 95% CI: 0.47 to 0.90; p = 0.008) and by 28% in SENTINEL (hazard ratio = 0.72; 95% CI: 0.54 to 0.98; p = 0.038, Cox proportional hazards models). Mean changes in vision scores from baseline were also significantly different, reflecting worsening in non-natalizumab groups. CONCLUSIONS: Natalizumab reduces visual loss in patients with relapsing multiple sclerosis. Low-contrast acuity testing has the capacity to demonstrate treatment effects and is a strong candidate for assessment of visual outcomes in future multiple sclerosis trials.

Original languageEnglish (US)
Pages (from-to)1299-1304
Number of pages6
Issue number16
StatePublished - Apr 1 2007

ASJC Scopus subject areas

  • Clinical Neurology

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  • Cite this

    Balcer, L. J., Galetta, S. L., Calabresi, P. A., Confavreux, C., Giovannoni, G., Havrdova, E., Hutchinson, M., Kappos, L., Lublin, F. D., Miller, D. H., O'Connor, P. W., Phillips, J. T., Polman, C. H., Radue, E. W., Rudick, R. A., Stuart, W. H., Wajgt, A., Weinstock-Guttman, B., Wynn, D. R., ... Panzara, M. A. (2007). Natalizumab reduces visual loss in patients with relapsing multiple sclerosis. Neurology, 68(16), 1299-1304.