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   DIR Return to: TYSABRI (natalizumab)
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       #Post#: 1495--------------------------------------------------
       (Abst.) Tysabri-related PML in MS: Findings from Italian
       independent registry
   DIR 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.
       --- End Quote ---
       The abstract can be seen here
  HTML https://www.ncbi.nlm.nih.gov/pubmed/27997580.
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