Risk stratification for progressive multifocal leukoencephalopathy in patients treated with natalizumab

被引：192

作者：

Sorensen, Per Soelberg ^{[1
,2
]}

Bertolotto, Antonio ^{[3
]}

Edan, Gilles ^{[4
]}

Giovannoni, Gavin ^{[5
]}

Gold, Ralf ^{[6
]}

Havrdova, Eva ^{[7
]}

Kappos, Ludwig ^{[8
,9
]}

Kieseier, Bernd C. ^{[10
]}

Montalban, Xavier ^{[11
]}

Olsson, Tomas ^{[12
]}

机构：

[1] Rigshosp, Dept Neurol, Copenhagen Univ Hosp, Danish Multiple Sclerosis Ctr, DK-2100 Copenhagen, Denmark

[2] Univ Copenhagen, DK-1168 Copenhagen, Denmark

[3] Ctr Riferimento Reg Sclerosi Multipla & Neurobiol, Orbassano, Italy

[4] CHU Rennes, INSERM, Serv Neurol, CIC P 0203, Rennes, France

[5] Queen Mary Univ London, Blizard Inst Cell & Mol Sci, Barts & London Sch Med & Dent, London, England

[6] Ruhr Univ Bochum, St Josef Hosp, Dept Neurol, Bochum, Germany

[7] Charles Univ Prague, Dept Neurol, Prague, Czech Republic

[8] Univ Basel Hosp, Dept Neurol, CH-4031 Basel, Switzerland

[9] Univ Basel Hosp, Dept Biomed, CH-4031 Basel, Switzerland

[10] Univ Dusseldorf, Dept Neurol, Dusseldorf, Germany

[11] HUVH, Unitat Neuroimmunol Clin, Barcelona, Spain

[12] Karolinska Inst, Ctr Mol Med, Stockholm, Sweden

来源：

MULTIPLE SCLEROSIS JOURNAL | 2012年 / 18卷 / 02期

基金：

英国医学研究理事会;

关键词：

Disease-modifying therapies; Tysabri; natalizumab; progressive multifocal leukoencephalopathy; PML; multiple sclerosis; risk assessment; PRIOR IMMUNOSUPPRESSANT USE; ANTI-JCV ANTIBODIES; TREATMENT DURATION; FUNCTIONAL STATUS; VIRUS; PML; INFECTION; PREVALENCE; BK;

D O I：

10.1177/1352458511435105

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Natalizumab is a highly effective immunomodulator in the treatment of multiple sclerosis (MS). Treatment with natalizumab has been associated with progressive multifocal leukoencephalopathy (PML), an infection of the central nervous system (CNS) caused by a pathogenic form of the normally benign JC virus (JCV). We searched PubMed and used current data from the natalizumab global safety database to assess risk factors and quantify the risk of PML. Natalizumab treatment duration and prior use of immunosuppressive therapies are established risk factors for development of PML in natalizumab-treated patients. With the development of a reliable and validated assay for detection of antibodies in patients with MS directed against JCV, it is now possible to identify persons who are carriers of JCV. The availability of this assay provides an additional option for risk stratification of PML in patients using or considering natalizumab therapy. Recommendations for clinical management of patients with MS and use of natalizumab are provided based on the presence of these three risk factors. The identification of risk factors that increase the likelihood of PML in natalizumab-treated patients can facilitate benefit-risk discussions between health care professionals and patients. Continued research and data collection will further develop our understanding of PML and the mechanisms by which these risk factors contribute to its development.

引用

页码：143 / 152

页数：10

共 41 条

[1]

Bloomgren G, 2011, MULT SCLER J, V17, pS451

[2]

Bozic C, 2010, MULT SCLER S10, V16, pS315

[3]

Bozic C, 2011, NEUROLOGY, V76, pA598

[4] Progressive multifocal leucoencephalopathy in the rheumatic diseases: assessing the risks of biological immunosuppressive therapies [J].