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DIR Return to: TYSABRI (natalizumab)
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#Post#: 1573--------------------------------------------------
(Abst.) No evidence of beneficial effects of plasmapheresis in T
ysabri-related PML
By: agate Date: February 24, 2017, 3:15 pm
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From PubMed, February 24, 2017:
[quote]Neurology. 2017 Feb 22.
No evidence of beneficial effects of plasmapheresis in
natalizumab-associated PML
Landi D1, De Rossi N1, Zagaglia S1, Scarpazza C1, Prosperini L1,
Albanese M1, Buttari F1, Mori F1, Marfia GA1, Sormani MP1, Capra
R2, Centonze D; Italian PML study group.
Collaborators (37)
Author information
1From the Multiple Sclerosis Clinical and Research Unit,
Department of Systems Medicine (D.L., M.A., F.B., F.M., G.A.M.,
D.C.), Tor Vergata University, Rome; IRCCS Istituto Neurologico
Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., G.A.M.,
D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R.,
C.S., R.C.), ASST-Spedali Civili di Brescia, Montichiari;
Neurological Clinic (S.Z.), Marche Polytechnic University,
Ancona; Department of Neurology and Psychiatry (L.P.), Sapienza
University, Rome; and Biostatistics Unit, Department of Health
Sciences (DISSAL) (M.P.S.), University of Genoa, Italy.
2From the Multiple Sclerosis Clinical and Research Unit,
Department of Systems Medicine (D.L., M.A., F.B., F.M., G.A.M.,
D.C.), Tor Vergata University, Rome; IRCCS Istituto Neurologico
Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., G.A.M.,
D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R.,
C.S., R.C.), ASST-Spedali Civili di Brescia, Montichiari;
Neurological Clinic (S.Z.), Marche Polytechnic University,
Ancona; Department of Neurology and Psychiatry (L.P.), Sapienza
University, Rome; and Biostatistics Unit, Department of Health
Sciences (DISSAL) (M.P.S.), University of Genoa, Italy.
ruggero.capra@gmail.com.
OBJECTIVE:
To examine retrospectively the effects of plasmapheresis (PLEX)
on the survival and clinical outcomes of patients with multiple
sclerosis (MS) and natalizumab (NTZ)-associated progressive
multifocal leukoencephalopathy (PML).
METHODS:
The medical literature was searched for the terms natalizumab
and progressive multifocal leukoencephalopathy. A total of 193
international and 34 Italian NTZ-PML cases were included.
Clinical outcome was determined by comparing the patients'
clinical status at PML diagnosis with status after PML
resolution. The effects on survival and clinical outcome of
PLEX, sex, age, country, pre-PML Expanded Disability Status
Scale score, NTZ infusion number, prior immunosuppressant
exposure, PML symptoms, PML lesion location at diagnosis, CSF JC
virus status and copies, additional PML treatments and steroids,
and PML immune reconstitution inflammatory syndrome (IRIS)
development were investigated with both univariate and
multivariate analyses.
RESULTS:
A total of 219 NTZ-PML cases were analyzed, and 184 (84%)
underwent PLEX, which did not reduce the mortality risk or the
likelihood of poor vs favorable outcomes. Country was predictive
of mortality and poor outcome, while PML-IRIS development was
predictive of poor outcome.
CONCLUSIONS:
PLEX did not improve the survival or clinical outcomes of
Italian or international patients with MS and NTZ-PML,
suggesting that this treatment should be performed cautiously in
the future.
CLASSIFICATION OF EVIDENCE:
This study provides Class III evidence that for patients with
NTZ-PML, PLEX does not improve survival. The study lacks the
statistical precision to exclude an important benefit or harm of
PLEX.[/quote]
This abstract can be seen here
HTML https://www.ncbi.nlm.nih.gov/pubmed/28228569.
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