NICE rethink widens access to natalizumab (Tysabri and Tyruko)

What is natalizumab?

Natalizumab is a disease modifying therapy (DMT) for relapsing remitting MS, with two brand names. Tysabri is the original brand, and Tyruko is the biosimilar. Natalizumab is taken as an infusion (through a drip) or as an injection. You usually have it every four weeks. Sometimes every six to eight weeks instead.

Natalizumab works by sticking to certain blood cells (T and B cells). This stops them getting into your brain and spinal cord so they can’t damage nerves there.

What’s changing?

NICE now say that people with ‘highly active’ relapsing MS can be eligible for natalizumab. Previously, they only recommended it for people with more severe relapsing remitting MS, known as ‘rapidly evolving severe’ MS.

The new recommendation says natalizumab is an option for highly active MS if you’ve already tried another DMT that didn’t work. And if the DMT cladribine isn’t suitable for you - for example, because you want to keep taking your DMT while pregnant. Unlike other highly effective DMTs, natalizumab can be taken throughout pregnancy, with the guidance of a neurologist.

Natalizumab is available as two different brands. The guidance applies to Tyruko given as an infusion (drip) and Tysabri given as an injection. It doesn’t apply to Tysabri infusions. This is because it wasn’t deemed cost effective.

We’re glad to see NICE widen the access to natalizumab. In March 2025, NICE decided not to recommend natalizumab for anyone with highly active relapsing remitting MS. We told them why giving more people another option would make a difference. We’re pleased they reversed the decision based on all the evidence.

If you’re not sure if you'd be eligible for natalizumab with the new NICE guidance, speak to your MS specialist. The new guidance doesn’t affect anyone already taking natalizumab.

Will it be available where I live?

The new NICE guidance applies to England. It’s likely to take a few months for each local NHS area to put it in place. Wales follows NICE guidance, while Northern Ireland usually decides after NICE guidance is published. In Scotland, natalizumab is already available for people with highly active MS who’ve tried another DMT.  

What does this mean for the MS community?

Emily, who was diagnosed with relapsing remitting MS in 2015 took part in the NICE process as a ‘patient expert’. She says:

Empowering people to effectively treat their MS whilst allowing them to fulfil other ambitions is critical. As a young woman whose MS was highly active, I was faced with the potential choice of a more effective treatment or having a baby. It made a huge difference talking to my MS team who told me that I didn't have to choose one or the other with natalizumab. I’m really pleased to see that NICE is recommending natalizumab as an option for more people so that so that they have more options to choose from to live their lives to the fullest.

Our Head of Policy, Ceri Smith, said: 

Natalizumab is a highly effective treatment and we’re really pleased that people with highly active relapsing MS who haven’t responded to previous DMT(s) will now have the option to take it. NICE’s decision will particularly benefit people who want to start a family as natalizumab can be taken during pregnancy, unlike other highly effective DMTs.