Treating MS after surviving PML: Discrete strategies for rescue, remission, and recovery patient 1: From the National Multiple Sclerosis Society Case Conference Proceedings.

Published on Jan 1, 2021in Neuroimmunology and Neuroinflammation7.724
· DOI :10.1212/NXI.0000000000000929
Nidhiben Anadani (UR: University of Rochester), Megan Hyland5
Estimated H-index: 5
+ 13 AuthorsTeresa Frohman1
Estimated H-index: 1
(UR: University of Rochester)
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Abstract
A 38-year-old woman with MS receiving natalizumab presented to the neurology clinic with the complaint of a new neurologic symptom. ### Clinical course The patient had a 6-year history of clinically stable MS, albeit exhibiting radiographic progression despite strict adherence to daily
References14
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#2Nick Hogan (University of Texas at Austin)H-Index: 1
Last. Teresa C. FrohmanH-Index: 37
view all 18 authors...
The patient is a right-handed White woman with relapsing-remitting MS diagnosed subsequent to left acute optic neuritis (AON). She described a previous transient episode of severe, electrical, and paroxysmal facial pain consistent with trigeminal neuralgia. Initial MRI demonstrated supratentorial
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#1Marinella Clerico (UNITO: University of Turin)H-Index: 23
#2Stefania De Mercanti (UNITO: University of Turin)H-Index: 11
Last. Ruggero CapraH-Index: 40
view all 28 authors...
Extending the natalizumab interval after the 24th administration could reduce the risk of progressive multifocal leukoencephalopathy (PML). The objective is to evaluate the noninferiority of the efficacy of an extended interval dosing (EID) compared with the standard interval dosing (SID) of natalizumab. It is an observational, multicenter (14 Italian centers), retrospective cohort study, starting from the 24th natalizumab infusion to the loss of follow-up or 2 years after baseline. Patients wer...
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#1Lana Zhovtis Ryerson (NYU: New York University)H-Index: 7
#2John Foley (NYU: New York University)H-Index: 6
Last. Nolan Campbell (NYU: New York University)H-Index: 1
view all 15 authors...
Objective To use the large dataset from the Tysabri Outreach: Unified Commitment to Health (TOUCH) program to compare progressive multifocal leukoencephalopathy (PML) risk with natalizumab extended interval dosing (EID) vs standard interval dosing (SID) in patients with multiple sclerosis (MS). Methods This retrospective cohort study included anti-JC virus antibody-positive patients (n = 35,521) in the TOUCH database as of June 1, 2017. The effect of EID on PML risk was evaluated with 3 planned ...
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#1Luca ProsperiniH-Index: 32
#2Revere P. Kinkel (UCSD: University of California, San Diego)H-Index: 13
Last. Simone Fantaccini (Biogen Idec)H-Index: 2
view all 5 authors...
Background:Natalizumab (NTZ) is sometimes discontinued in patients with multiple sclerosis, mainly due to concerns about the risk of progressive multifocal leukoencephalopathy. However, NTZ interru...
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#1Pei-Ran Ho (Biogen Idec)H-Index: 7
#2Harold Koendgen (Biogen Idec)H-Index: 12
Last. Ih Chang (Biogen Idec)H-Index: 10
view all 6 authors...
Summary Background Previous estimates of risk of progressive multifocal leukoencephalopathy (PML) in patients with multiple sclerosis receiving natalizumab were stratified by three risk factors: anti-John Cunningham virus (JCV) antibodies in serum, previous immunosuppressant use, and treatment duration, which were estimated using population-based assumptions. We aimed to calculate PML risk estimates from patient-level risk-factor data and to stratify risk by concentrations of anti-JCV antibody i...
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OBJECTIVE: To describe the clinico-radiologic outcome of MS patients with natalizumab-related progressive multifocal leukoencephalopathy (Nz-PML) surviving and receiving disease-modifying therapy (DMT). METHODS: We describe clinical and radiologic evolution of Nz-PML survivors in an observational retrospective multicenter cohort to clarify the effect of different subsequent MS DMT strategies. Twenty-three patients from 11 centers were analyzed. Outcomes were (1) clinical efficacy of post-PML MS ...
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#1L. Zhovtis Ryerson (NYU: New York University)H-Index: 1
#2Teresa C. Frohman (UTSW: University of Texas Southwestern Medical Center)H-Index: 37
Last. Roberto Bomprezzi (UMMS: University of Massachusetts Medical School)H-Index: 15
view all 28 authors...
Background Natalizumab (NTZ), a monoclonal antibody to human α 4 β 1 /β 7 integrin, is an effective therapy for multiple sclerosis (MS), albeit associated with progressive multifocal leukoencephalopathy (PML). Clinicians have been extending the dose of infusions with a hypothesis of reducing PML risk. The aim of the study is to evaluate the clinical consequences of reducing NTZ frequency of infusion up to 8 weeks 5 days. Methods A retrospective chart review in 9 MS centres was performed in order...
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#1Robert HoepnerH-Index: 15
#2Simon FaissnerH-Index: 15
Last. Ralf Gold (RUB: Ruhr University Bochum)H-Index: 86
view all 5 authors...
Today, a growing armamentarium of potent immunotherapies exists for the treatment of severe relapsing remitting multiple sclerosis (RRMS). Some of these drugs may cause progressive multifocal leukoencephalopathy (PML), a John Cunningham virus (JCV) infection of the central nervous system [Dahlhaus et al. 2013; Hoepner et al. 2014; Schmedt et al. 2012]. In PML survivors, RRMS-disease activity will usually return to high pre-natalizumab (Nat) levels within 1 year [Dahlhaus et al. 2013]. Thus a pos...
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#1Elisabeth MaillartH-Index: 17
#2Céline LouapreH-Index: 19
Last. Caroline PapeixH-Index: 28
view all 4 authors...
We report two cases of multiple sclerosis (MS) patients with natalizumab-associated progressive multifocal leukoencephalopathy. Severe MS relapses occurred between four and five months after natalizumab discontinuation. After failure of immunomodulatory treatment, both patients were treated with fingolimod. The outcome was positive on clinical and MRI disease activity, without worsening of the progressive multifocal leukoencephalopathy. These observations suggest that using fingolimod for severe...
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#8Eugene O. Major (NIH: National Institutes of Health)H-Index: 8
Objective: To establish criteria for the diagnosis of progressive multifocal leukoencephalopathy (PML). Methods: We reviewed available literature to identify various diagnostic criteria employed. Several search strategies employing the terms “progressive multifocal leukoencephalopathy” with or without “JC virus” were performed with PubMed, SCOPUS, and EMBASE search engines. The articles were reviewed by a committee of individuals with expertise in the disorder in order to determine the most usef...
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