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Natalizumab-Related Progressive Multifocal Leukoencephalopathy in Multiple Sclerosis: Findings from an Italian Independent Registry
- Source :
- PLoS ONE, Vol 11, Iss 12, p e0168376 (2016), PLoS ONE
- Publication Year :
- 2016
- Publisher :
- Public Library of Science (PLoS), 2016.
-
Abstract
- Background The monoclonal antibody natalizumab (NTZ) is a highly effective treatment for patients with multiple sclerosis (MS). However, this drug is associated with increased risk of developing Progressive Multifocal Leukoencephalopathy (PML), an opportunistic infection of central nervous system (CNS) caused by the John Cunningham polyomavirus (JCV). Objective To describe the 12-month clinical course of 39 patients with MS (28 women, 11 men) who developed NTZ-related PML after a mean exposure of 39 infusions. Methods An Italian independent collaborative repository initiative collected and analyzed socio-demographic, clinical, magnetic resonance imaging (MRI) data and number of JCV-DNA copies detected on cerebrospinal fluid (CSF) samples of patients diagnosed as affected by NTZ-related PML. The evolution of disability, measured by the Expanded Disability Status Scale, was assessed at NTZ start, at PML diagnosis and after 2, 6 and 12 months from PML diagnosis. The effect of clinical and paraclinical characteristics at PML diagnosis on the final outcome was also investigated. Results Ten patients (25.6%) were diagnosed before 24 NTZ infusions. In six cases (15.4%) the PML suspect was made on the basis of highly suggestive MRI findings in absence of any detectable change of clinical conditions (asymptomatic PML). In patients with symptomatic PML, the diagnosis was quicker for those who presented with cognitive symptoms (n = 12) rather than for those with other neurological pictures (n = 21) (p = 0.003). Three patients (7.7%) died during the 12-month observation period, resulting in a survival rate of 92.3%. Asymptomatic PML, more localized brain involvement and gadolinium-enhancement detected at MRI, as well as lower viral load were associated with a better disability outcome (p-values
- Subjects :
- Male
Central Nervous System
Genetics and Molecular Biology (all)
0301 basic medicine
Pathology
Physiology
viruses
JC virus
lcsh:Medicine
Medicine (all)
Biochemistry, Genetics and Molecular Biology (all)
Agricultural and Biological Sciences (all)
Pathology and Laboratory Medicine
medicine.disease_cause
Nervous System
Biochemistry
Diagnostic Radiology
Leukoencephalopathy
0302 clinical medicine
Natalizumab
Medicine and Health Sciences
Ethnicities
lcsh:Science
Immune Response
Cerebrospinal Fluid
Multidisciplinary
Cognitive Neurology
Radiology and Imaging
Progressive multifocal leukoencephalopathy
Leukoencephalopathy, Progressive Multifocal
Middle Aged
JC Virus
Magnetic Resonance Imaging
Body Fluids
Italian People
Survival Rate
Neurology
Female
Anatomy
medicine.symptom
Research Article
medicine.drug
Adult
medicine.medical_specialty
Multiple Sclerosis
Imaging Techniques
Cognitive Neuroscience
Immunology
Progressive Multifocal
Research and Analysis Methods
Asymptomatic
Disease-Free Survival
Humans
Retrospective Studies
03 medical and health sciences
Signs and Symptoms
Diagnostic Medicine
Internal medicine
medicine
Survival rate
Inflammation
Expanded Disability Status Scale
business.industry
Multiple sclerosis
lcsh:R
Biology and Life Sciences
medicine.disease
030104 developmental biology
People and Places
Lesions
Cognitive Science
Population Groupings
lcsh:Q
business
030217 neurology & neurosurgery
Neuroscience
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 11
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....22e70f16c7b872b317b72d1cf6d6d769