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As natalizumab does not reduce circulating lymphocyte counts, rather it blocks their entry to the CNS resulting in only mild lymphocytosis,Reference Fox, Kita and Cohan 137 , Reference Miller 138 there may be limited benefit in delaying initiating treatment with another DMT following natalizumab discontinuation.Reference Miller 138 It has also been suggested that starting a new treatment immediately after stopping natalizumab (without washout period) may be more beneficial because the risk of developing PML is lower than the risk of a severe relapse.Reference Polman, OConnor and Havrdova 139 , Reference Gallo and Van Wijmeersch 140 However, despite preferred outcomes in the absence of a prolonged washout period after natalizumab, it is important when switching to confirm JCV status and exclude any PML carryover in JCV-positive patients by MRI and by cerebrospinal fluid examination for JCV DNA, before treatment initiation

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Ferroptosis induces heterogeneous death profiles that are controlled by lysosome rupture

222 , 757768, doi: 10.1002/jcp.22008 (2010)