Natalizumab-associated progressive multifocal leucoencephalopathy: a practical approach to risk profiling and monitoring

@article{Hunt2012NatalizumabassociatedPM,
  title={Natalizumab-associated progressive multifocal leucoencephalopathy: a practical approach to risk profiling and monitoring},
  author={David Hunt and Gavin Giovannoni},
  journal={Practical Neurology},
  year={2012},
  volume={12},
  pages={25 - 35}
}
Natalizumab reduces relapse frequency, delays onset of disease progression and improves disease outcomes in relapsing–remitting multiple sclerosis (MS) and is a cost-effective treatment for rapidly evolving severe relapsing–remitting MS. However, it is associated with the development of progressive multifocal leucoencephalopathy (PML), a serious opportunistic brain infection caused by a neurotropic strain of the JC virus (JCV). Until May 2011, 83 300 patients had received natalizumab for MS… 
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TLDR
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TLDR
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TLDR
Body weights of NTZtreated patients in EU were lower than those in the US, and low BW could be a potential surrogate risk factor for PML in MS patients treated by NTZ, according to Foley et al.
Progressive Multifocal Leukoencephalopathy in Patients with a Hematological Malignancy: Review of Therapeutic Options
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Rapidly progressive cerebellar ataxia in West Wales
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TLDR
Natalizumab-associated PML has improved survival compared with PML in other populations and a shorter time from symptom onset to diagnosis and localized disease on MRI at diagnosis were associated with improved survival.
Natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: lessons from 28 cases
TLDR
D diagnosis of natalizumab-associated PML requires optimised clinical vigilance, reliable and sensitive PCR testing of the JC virus, and broadened criteria for recognition of PML lesions by use of MRI, including contrast enhancement.
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There is currently no convincing evidence that natalizumab-associated PML is restricted to combination therapy with other disease-modifying or immunosuppressive agents.
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TLDR
A detailed review of possible cases ofPML in patients exposed to natalizumab found no new cases and suggested a risk of PML of roughly 1 in 1000 patients treated with natalIZumab for a mean of 17.9 months.
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TLDR
Screening for JCV in CSF in natalizumab-treated patients could help identify those at heightened risk for developing PML and discontinuing treatment in these patients may abort development of the clinical illness.
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TLDR
The link between the effects of these therapies on the immune system and the occurrence of PML has prompted investigations on JCV sites of latency in the bone marrow, the migration of bone marrow derived cells into the circulation, and intracellular virus entry into the brain.
JC virus persistence following progressive multifocal leukoencephalopathy in multiple sclerosis patients treated with natalizumab
JC virus (JCV) DNA in the cerebrospinal fluid (CSF) provides the laboratory confirmatory diagnosis of progressive multifocal leukoencephalopathy (PML) in patients whose clinical symptoms and magnetic
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TLDR
The presence of JC virus (JCV)-specific cytotoxic T-lymphocytes (CTL) was associated with a trend toward longer survival in patients with progressive multifocal leukoencephalopathy (PML), which was more pronounced than the impact of CD4 count in HIV+ patients with PML early after diagnosis.
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