Patient description: The patient is a 20 year old Caucasian female presents to the clinic with one-sided vision lost and facial weakness, dysarthria and numbness lasting for 1 day. She visited her PCP and underwent brain MRI which revealed a single plaque in the brainstem. After few months, she experienced lower extremities weakness led to balance problem. The second MRI revealed another lesion in the left cerebral hemisphere. The diagnosis of Relapsing Remitting Multiple Sclerosis (RRMS) is confirmed after the second MRI. Her past surgical history is significant for a C-section 2 years ago and she has a one child. She is divorced and is not currently in any sexual relationship. She smokes 10 cigarettes per day and drinks alcohol occasionally. She is working as an editor in a publisher company and she is happy that she can keep working from home most of the time. She is under the treatment of RRMS from 7 months ago.

Clinical trial eligibility criteria: eligible ages (years): 18.0-60.0,  Multiple Sclerosis, Relapsing-Remitting Key For Part 1 Ability of the participant to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use confidential health information in accordance with national and local participant privacy regulations Diagnosis of relapsing remitting multiple sclerosis (RRMS) according to the McDonald [Thompson 2018] Treatment with natalizumab as disease-modifying monotherapy for RRMS that is consistent with the approved dosing for a minimum of 12 months prior to randomization. The participant must have received at least 11 doses of natalizumab in the 12 months prior to randomization with no missed doses in the 3 months prior to randomization Expanded Disability Status Scale (EDSS) score <=5.5 at screening No relapses in the last 12 months prior to randomization, as determined by the enrolling Investigator. For Part 2 Ability of the participants to understand the purpose and risks of the study and provide signed and dated informed consent for Part 2 and authorization to use confidential health information in accordance with national and local participant privacy regulations Completed Part 1 Week 72 visit while remaining on their randomized treatment assignment of SID or EID. Key  For Part 1 Primary and secondary progressive multiple sclerosis (MS) MRI positive for Gd-enhancing lesions at screening Participants for whom MRI is contraindicated (e.g., have a contraindicated pacemaker or other contraindicated implanted metal device, have suffered, or are at risk for, side effects from Gd, or have claustrophobia that cannot be medically managed) History of any clinically significant (as determined by the Investigator) cardiac, endocrinologic, hematologic, hepatic, immunologic, metabolic (including diabetes), urologic, pulmonary, neurologic (except for RRMS), dermatologic, psychiatric, renal, or other major disease that would preclude participation in a clinical study, in the opinion of the Investigator Presence of anti-natalizumab antibodies at screening. For Part 2 Participants treated with natalizumab EID was reverted to natalizumab SID by choice or as rescue treatment in Part 1 Participant received treatment with any MS disease-modifying therapy other than natalizumab in Part 1 or in the period between Part 1 and Part 2 History of human immunodeficiency virus or history of other immunodeficient conditions Current enrollment or a plan to enroll in any interventional clinical study in which an investigational treatment or approved therapy for investigational use is administered within 30 days (or 5 half-lives of the agent, whichever is longer) prior to the Baseline Visit or at any time during this study