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   DIR Return to: TYSABRI (natalizumab)
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       #Post#: 1495--------------------------------------------------
       (Abst.) Tysabri-related PML in MS: Findings from Italian indepen
       dent registry
       By: agate Date: December 22, 2016, 10:00 pm
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       From PubMed, December 22, 2016:
       [quote]PLoS One. 2016 Dec 20;11(12):e0168376.
       Natalizumab-Related Progressive Multifocal Leukoencephalopathy
       in Multiple Sclerosis: Findings from an Italian Independent
       Registry.
       Prosperini L, de Rossi N, Scarpazza C, Moiola L, Cosottini M,
       Gerevini S, Capra R; Italian PML study group.
       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)  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<0.01).
       CONCLUSION:
       Our findings support that early PML diagnosis, limited CNS
       involvement and initial signs of immune restoration are
       associated with a better outcome and higher survival rate, and
       confirm the utility of MRI as a surveillance tool for
       NTZ-treated patients.[/quote]
       The abstract can be seen here
  HTML https://www.ncbi.nlm.nih.gov/pubmed/27997580.
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