Concierge MS neurology · UK
Natalizumab (Tysabri) for relapsing–remitting MS, by a consultant MS neurologist.
A high-efficacy disease-modifying therapy for active RRMS - with JCV risk stratified honestly, monitoring built in, and the alternatives (ocrelizumab, ofatumumab, alemtuzumab, cladribine) genuinely on the table.
Why patients choose us
- 01
A named MS neurologist, not a shared clinic
One consultant MS neurologist across your JCV screening, infusion planning and follow-up - not a rotating team.
- 02
JCV risk stratified before you start
JCV antibody, index and prior immunosuppression are weighed openly - including the 2-year cliff and when to switch.
- 03
Independent, and free
We are paid by no clinic, so the recommendation between natalizumab, ocrelizumab, ofatumumab, alemtuzumab or cladribine is impartial and costs you nothing.
Indicative pricing
What private natalizumab (Tysabri) treatment costs in the UK.
Indicative ranges across our partner MS units. NHS treatment is commissioned per NICE TA127 at no cost to eligible patients; private costs are per infusion plus monitoring.
In short
One private natalizumab infusion in our network: £3,000–£4,500, home the same day.
| Item | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Natalizumab infusion (per dose, 300 mg IV) | £3,000–£4,500 | 2–3 hr visit | Same day home |
| Baseline MS work-up (MRI + bloods + JCV) | £1,200–£2,000 | Half-day | 3–5 days |
| JCV antibody and index (standalone) | £180–£320 | 15 min draw | 5–10 days |
| MRI brain with gadolinium (monitoring) | £600–£950 | 45 min | 24–72 hr |
| MS neurology consultation | £300–£500 | 45 min | Same visit |
| DMT switch planning consultation | £300–£500 | 45 min | Same visit |
Prices vary by unit, by whether infusions are four- or six-weekly, and by the frequency of MRI and JCV monitoring built into your plan. We come back with a firm figure across two or three options within one working day.
The problem
The right DMT, the right monitoring, the right exit plan.
High-efficacy MS therapy is a decision that lives with you for years. Natalizumab is exceptional in the right person - and the wrong long-term choice in others. We help you see the difference before you commit.
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Not sure natalizumab is right?
Ocrelizumab, ofatumumab, alemtuzumab or cladribine may fit better for your JCV status and life plans. We say so before you start.
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Worried about PML?
JCV antibody, index, prior immunosuppression and duration are laid out clearly - including six-weekly dosing and the two-year switch conversation.
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Planning pregnancy or a switch?
Rebound MS on stopping is real. The bridging strategy to the next DMT is planned up front, not improvised later.
The journey
From enquiry to ongoing monitoring - what happens, in order.
One MS neurologist from first message to every three-monthly review - including the JCV conversation.
Phase 1 · Before treatment
Concierge, off-stage for you
Phase 2 · Infusion day
A few hours at the unit
Phase 3 · Ongoing
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Diagnosis, relapse history, current DMT, MRI activity, and whether you have had immunosuppressants before.
- 02
Before
We come back with a recommendation
Within one working day: whether natalizumab fits the NICE TA127 criteria for you, JCV testing needed first, and an indicative price. If a different high-efficacy DMT fits better, we say so.
- 03
Before
Baseline screen and MRI
JCV antibody and index, MRI with gadolinium, HIV/HBV/HCV/latent TB, LFTs, U+Es, FBC, VZV IgG, pregnancy plans discussed.
- 04
Infusion day
Arrival at the infusion unit
Consent and a chat with the MS nurse and neurologist. Observations, cannula, pre-infusion checks.
- 05
Infusion day
The infusion itself
300 mg intravenous natalizumab over one hour, with a one-hour observation window afterwards for any infusion reaction.
- 06
Infusion day
Home the same day
Cannula out, written aftercare, and home within three to four hours. You can drive yourself unless you had a reaction.
- 07
Ongoing
Ongoing monitoring
Four-weekly infusions (or six-weekly extended-interval where appropriate), three-monthly MRI and JCV review, NEDA-3 status tracked.
Typical end-to-end: 2–3 weeks from enquiry to first infusion. Treatment horizon: reviewed at 2 years for JCV-positive patients.
When it helps
When natalizumab is the right high-efficacy DMT.
The situations that fit NICE TA127, plus the one red flag that means an urgent MRI rather than a routine appointment.
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Rapidly evolving severe RRMS
Two or more disabling relapses in 12 months plus a gadolinium-enhancing lesion or nine T2 lesions on MRI - the NICE TA127 first-line criterion.
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Relapses on interferon or glatiramer
High disease activity despite a first-line DMT - natalizumab is one of the high-efficacy options offered.
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JCV antibody negative
Where the JCV screen is negative, PML risk is around 0.1 per 1,000 patient-years - the setting natalizumab was designed for.
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MRI activity despite treatment
New T2 or gadolinium-enhancing lesions on a current DMT - a signal to escalate to a high-efficacy agent.
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Progressive disability from relapses
Sustained EDSS progression driven by incomplete relapse recovery, not slow secondary progression.
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Planning pregnancy with active disease
A conversation, not a decision - some women continue natalizumab under specialist supervision in severe active disease.
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Bridging before another DMT
Occasionally used as a controlled bridge before ocrelizumab, cladribine or another agent - the transition matters more than the drug.
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Red flag: new neurological symptoms
Progressive cognitive change, personality shift, visual disturbance or new weakness on natalizumab needs same-day MRI to rule out PML.
Treatment options
Natalizumab is not the only high-efficacy DMT.
What each option on the table actually involves - and which fits which situation, JCV status and life plan.
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Standard 4-weekly infusion
300 mg IV every four weeks - the licensed schedule with the strongest efficacy evidence from the AFFIRM trial.
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Extended-interval 6-weekly dosing
Every six weeks in JCV-positive patients on longer-term treatment - NOVA and TRUST data suggest retained efficacy with a lower PML signal.
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Natalizumab as first high-efficacy DMT
Used up front in rapidly evolving severe RRMS where hitting hard early is the goal, especially if JCV negative.
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Switch from a first-line DMT
Escalation after breakthrough relapses or MRI activity on interferon, glatiramer, teriflunomide or dimethyl fumarate.
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Bridge before another agent
A short course to control disease while preparing for ocrelizumab, cladribine or alemtuzumab - with a careful hand-off.
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Planned de-escalation
Stopping natalizumab after two years in JCV-positive patients - transitioned to another high-efficacy DMT to avoid rebound.
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Comparison with ocrelizumab or ofatumumab
Anti-CD20 antibodies - different mechanism, no PML risk stratification in the same way, often preferred for JCV-positive long-term treatment.
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Consultation only
An honest discussion of whether natalizumab fits - versus alemtuzumab, cladribine, ocrelizumab or ofatumumab - no obligation.
Our vetted UK network
A small panel of MS neurologists, we picked them.
Consultant MS neurologists in London and specialist centres across the UK. Not listed publicly - introductions are made privately, once we understand your case.
Selection criteria
How we choose every MS neurologist in our network.
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Consultant MS neurologists, not general neurologists
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Day-case infusion units with anaphylaxis and PML pathways in place
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JCV antibody, index and MRI monitoring built into the follow-up schedule
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Access to ocrelizumab, ofatumumab, alemtuzumab and cladribine for comparison and switching
Safety and monitoring
What to expect on natalizumab - honestly.
Natalizumab is one of the most effective MS therapies we have. The things worth planning are JCV status, the two-year switch conversation, and the specific symptoms that mean an urgent MRI.
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PML is the hallmark risk
Progressive multifocal leukoencephalopathy - a JCV-driven brain infection. Rare in JCV-negative patients; rising with treatment beyond two years, JCV positivity and prior immunosuppression.
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JCV status is not a one-off
JCV antibody is rechecked every six months if negative, and the index value is tracked over time. Positive high-index status changes the calculus.
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Infusion reactions in around 4–6%
Flushing, urticaria, rigors or breathlessness during or shortly after the infusion - usually managed on the day, occasionally a reason to stop.
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Herpes reactivation and rare hepatitis
Shingles, oral or genital HSV can flare; LFTs are checked periodically for the rare cases of drug-induced liver injury.
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Rebound MS on stopping
Disease activity can surge in the three to six months after natalizumab is stopped - a bridging strategy to the next DMT is essential, not optional.
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Pregnancy is a specialist conversation
Generally avoided, but continued in some women with severe active disease under close specialist supervision. Third-trimester use can cause mild neonatal cytopenia.
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Anti-natalizumab antibodies
Around 6% develop persistent neutralising antibodies - reduced efficacy and more infusion reactions are the signal to check and switch.
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Melanoma vigilance
A theoretical signal only - annual skin checks are sensible, and any new or changing pigmented lesion is reviewed promptly.
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Red flags
New cognitive change, personality shift, visual field loss, weakness or ataxia on natalizumab needs urgent MRI and neurology review the same day - not a routine appointment.
Reading your treatment note
Your MS treatment note in four parts. Read the last one first.
Whichever schedule you are on, the letter the MS neurologist sends after each review keeps to the same shape.
A quiet reminder
Neurology language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note or MRI report before your review, just ask.
- 01 Header
Diagnosis, indication and DMT chosen
RRMS with the criteria met - relapse count, MRI lesion load, prior DMT - and why natalizumab was chosen over the alternatives.
- 02 Technique
JCV status, dosing schedule and infusion
JCV antibody and index, the schedule (four- or six-weekly), infusion tolerance and any pre-medication needed.
- 03 Findings
MRI activity, NEDA-3 and bloods
New or enhancing lesions since baseline, relapse history since starting, and results of LFTs, FBC and repeat JCV serology.
- 04 Impression
Plan, review timing and stop criteria
Read this first: next infusion date, next MRI and JCV date, and the specific triggers that would prompt a switch or stop.
Recognised by major UK insurers
Insurer cover for natalizumab varies - most NHS patients are treated under NICE TA127 at no cost. Private cover for high-cost biologics is often subject to prior authorisation. We confirm cover before booking.
Frequently asked
Everything we get asked about natalizumab.
Quick answers on efficacy, JCV, dosing, pregnancy and how it compares with ocrelizumab, ofatumumab, alemtuzumab and cladribine.
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What is natalizumab and how does it work?
Natalizumab (brand name Tysabri) is a humanised monoclonal antibody that blocks α4-integrin (VLA-4) on lymphocytes, stopping them crossing the blood–brain barrier. Less immune traffic into the central nervous system means far less MS inflammation - but it also reduces immune surveillance of the brain, which is why PML is a specific risk.
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Who is natalizumab licensed for in the UK?
NICE TA127 (2007) recommends natalizumab for adults with rapidly evolving severe relapsing–remitting MS (at least two disabling relapses in 12 months with a gadolinium-enhancing lesion or nine T2 lesions on MRI), or for people with high disease activity despite a full course of a β-interferon.
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How effective is natalizumab?
In the AFFIRM trial, natalizumab reduced the annualised relapse rate by 68%, sustained disability progression by 42%, and MRI activity by around 92% compared with placebo over two years - placing it firmly in the high-efficacy DMT tier.
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What is JCV antibody testing and why does it matter?
The John Cunningham virus (JCV) is a common virus that stays latent in most healthy adults. On natalizumab it can reactivate and cause progressive multifocal leukoencephalopathy (PML). JCV antibody status, antibody index, treatment duration and prior immunosuppression together determine PML risk - from around 0.1 per 1,000 patient-years if negative up to about 12 per 1,000 in the highest-risk group.
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How is natalizumab given?
300 mg as an intravenous infusion over one hour in a day-case unit, followed by a one-hour observation window. The standard schedule is every four weeks; extended-interval dosing every six weeks is used in selected JCV-positive patients to reduce PML risk while retaining efficacy.
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How much does private natalizumab cost in the UK?
Roughly £3,000–£4,500 per infusion, plus a baseline MS work-up (MRI, JCV serology and bloods) of £1,200–£2,000 and ongoing three-monthly MRI at £600–£950. On the NHS, treatment is commissioned per NICE TA127 at no cost to eligible patients.
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How does natalizumab compare with ocrelizumab, ofatumumab, alemtuzumab and cladribine?
All five are high-efficacy DMTs. Natalizumab has excellent early efficacy but the JCV/PML issue after two years. Ocrelizumab and ofatumumab (anti-CD20 antibodies) are often preferred for long-term treatment in JCV-positive patients. Alemtuzumab is pulsed and highly effective but carries autoimmune thyroid and ITP risks. Cladribine is oral, short-course, with a distinct risk profile. Choice is an individualised MDT decision.
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What happens if I stop natalizumab?
MS activity can rebound within three to six months of stopping - sometimes worse than before treatment. Any stop should be planned with a bridging strategy to another DMT (often ocrelizumab or cladribine) and, in some cases, short-course steroids to smooth the transition.
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Can I have children on natalizumab?
Ideally pregnancy is planned around treatment, but some women with very active MS continue natalizumab under close specialist supervision, sometimes into the third trimester. Third-trimester exposure can cause mild neonatal thrombocytopenia or anaemia. This is a conversation with your MS neurologist, not a fixed rule.
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When should I contact the team urgently?
New cognitive change, personality shift, visual disturbance, weakness, ataxia or seizure on natalizumab is a PML red flag - call the MS team the same day for urgent MRI. A severe infusion reaction, shingles-type rash, jaundice or unexplained bruising also warrant prompt review.
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