Four cases of natalizumab-related PML: a less severe course in extended interval dosing?

Four cases of natalizumab-related PML: a less severe course in extended interval dosing?

Publication date: Jun 07, 2019

Progressive multifocal leukoencephalopathy (PML) is a severe adverse event of natalizumab (NTZ). The administration of NTZ with extended interval dosing (EID) has been proposed as a strategy to potentially reduce the incidence of PML while maintaining its therapeutic efficacy.

In the current paper, we describe 4 cases of NTZ-PML in EID included in the Italian PML cohort.

The patients developed PML after at least 38 NTZ infusions. Their John Cunningham virus (JCv) index was > 1.5, and patients had not previously used immunosuppressant. Two patients were asymptomatic at PML onset, while two had mild motor impairment of the right hand and anomia, respectively. All of them had undetectable viral load but one (37 JCv copies/ml). In all patients, MRI revealed unilobar lesions with deferred contrast enhancement suggestive of immune reconstitution. The clinical course ended with a favorable clinical outcome (ΔEDSS up to 1).

Although PML in EID seems to occur less frequently than in conventional dosing regimen, strict monitoring of high-risk patients contributed to the indolent course observed in the four described cases, characterized by a prolonged pre-symptomatic phase, paucisymptomatic onset, low JCv load, less severe functional impairment during immune reconstitution, and a mild disability burden.

Scarpazza, C., De Rossi, N., Tabiadon, G., Turrini, M.V., Gerevini, S., and Capra, R. Four cases of natalizumab-related PML: a less severe course in extended interval dosing? 18278. 2019 Neurol Sci.

Concepts Keywords
Adverse Event Viruses
Anomia Medical specialties
Asymptomatic Microbiology
Cohort Progressive multifocal leukoencephalopathy
Disability Immunosuppressants
Immunosuppressant Polyomaviridae
Incidence Natalizumab
Italian Human polyomavirus 2
John Cunningham PML
MRI Multiple sclerosis
Natalizumab MRI
PML
Progressive Multifocal Leukoencephalopathy
Sci
Viral Load
Virus

Semantics

Type Source Name
disease DOID Multiple sclerosis
disease MESH Multiple sclerosis
disease MESH diagnosis
gene UNIPROT CYREN
disease MESH viral load
disease DOID anomia
disease MESH anomia
disease MESH Progressive multifocal leukoencephalopathy
gene UNIPROT PML
disease DOID PML
drug DRUGBANK Natalizumab

Similar

Original Article

Leave a Comment

Your email address will not be published. Required fields are marked *