Natalizumab (natalizumab-sztn) now recommended in England to treat hard-to-control MS

NICE decision will allow NHS coverage of Tysabri, Tyruko for relapsing-remitting MS

Written by Marisa Wexler, MS | January 6, 2026

• The National Institute for Health and Care Excellence in England has recommended natalizumab, sold as Tysabri and Tyruko, to treat hard-to-control MS.
• The approved medication is indicated for people with highly active relapsing-remitting MS that’s unresponsive to other therapies.
• The NICE recommendation will allow NHS coverage of the medication in England.

The National Institute for Health and Care Excellence (NICE) in England is recommending natalizumab — sold as Tysabri and Tyruko — as an option for certain people with hard-to-control multiple sclerosis (MS).

NICE is responsible for deciding which medicines will be covered by the National Health Service (NHS) in England, with decisions also influencing NHS coverage in other parts of the U.K.

The new final draft guidance specifically recommends natalizumab as an option for people with relapsing-remitting MS (RRMS) — characterized by periods of new or worsening symptoms interspersed with periods of remission —whose disease remains highly active after a full course of at least one disease-modifying therapy, and for whom the short-course oral MS therapy Mavenclad (cladribine) is not suitable.

“This recommendation means people living with highly active relapsing-remitting MS now have a meaningful additional treatment option,” Helen Knight, director of medicines evaluation at NICE, said in a press release from the agency announcing the decision.

“Having choice matters enormously to people managing a lifelong condition — it allows individuals and their clinicians to select the treatment that best fits their personal circumstances,” Knight added.

The decision specifically applies to a subcutaneous, or under-the-skin, formulation of Tysabri, the name-brand medication marketed by Biogen. It does not cover the intravenous, or into-the-vein, formulation of Tysabri, which is the only version of the medication approved in the U.S.

The recommendation also covers Tyruko (natalizumab-sztn), a biosimilar of Tysabri that’s given by infusion into the bloodstream and is sold by Sandoz.

Biosimilars are medications that are functionally identical to name-brand biologic medicines. Much like generic therapies for traditional medicines, biosimliars are usually cheaper than their name-brand counterparts. Tyruko is currently approved as an alternative to intravenous Tysabri in Europe and the U.S.

Recommendation gives more treatment options to people with RRMS

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