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MS – DMT Escalation Decision — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS – DMT Escalation DecisionSCE Neurology

A 35-year-old man with RRMS has breakthrough disease activity on dimethyl fumarate (2 relapses and new MRI lesions in 12 months). His neurologist plans escalation to a high-efficacy DMT. He is JCV antibody negative. He has no comorbidities. Which factor most strongly supports choosing natalizumab over ocrelizumab in this patient?

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Correct answer: D — He is JCV antibody negative

JCV antibody negativity makes natalizumab a relatively safe option with respect to PML risk. Natalizumab is one of the most efficacious DMTs for relapse suppression and is particularly advantageous in patients who are JCV antibody negative (PML risk <0.1/1000). Regular JCV testing every 6 months is required as seroconversion can occur. A: Sex does not specifically guide DMT choice between these agents. C: Both agents are used after prior DMT failure. D: Age alone does not guide this choice. E: Spinal cord lesion burden does not differentially guide natalizumab vs ocrelizumab.

Reference: NICE TA127/TA1126 Natalizumab; NICE TA533 Ocrelizumab; ABN MS Guidelines (2022)