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Neurol Neuroimmunol Neuroinflamm. 2017 Apr 14;4(3):e346. doi: 10.1212/NXI.0000000000000346. eCollection 2017 May.

Natalizumab-PML survivors with subsequent MS treatment: Clinico-radiologic outcome.

Author information

1
Department of Neurology (E.M., C. Louapre, C. Lubetzki, C.P.), Pitié-Salpêtrière Hospital, APHP, Paris; Department of Gerontology (J.-S.V.), Broca Hospital, APHP, Paris; Department of Neurology (D.B.), University Hospital of Toulouse; Department of Neurology (B.S.), Saint-Antoine Hospital, APHP, Paris; Department of Neurology (A.F., T.M.), University Hospital of Dijon; Department of Neurology (J.d.S.), University Hospital of Strasbourg; Department of Neurology (F.T., P.C.), University Hospital of Clermont-Ferrand; Department of Neurology (B.B.), University Hospital of Rouen, France; Department of Neurology (V.D.), University Hospital of Liège, Belgium; APHM (A.R., J.P.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille; Department of Neurology (P.L.), University Hospital of Montpellier; Department of Neurology (A.T.), University Hospital of Reims, URCA Reims, and LPN EA 2027 University Paris 8, Saint-Denis; and Department of Neurology (C. Lebrun), University Hospital of Nice, France.

Abstract

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 DMT, (2) radiologic efficacy of post-PML MS DMT, (3) radiologic evolution of PML lesion, and (4) disability progression.

RESULTS:

There was no clinical worsening of PML symptoms with a stability of Expanded Disability Status Scale at the last follow-up. No relapse was reported with fingolimod and dimethyl fumarate. No radiologic worsening of Nz-PML lesion was observed at the end of the follow-up.

CONCLUSION:

In this large cohort of patients with Nz-PML, MS therapies given after Nz discontinuation were not associated with PML worsening. A larger cohort with longer follow-up will be necessary to confirm this therapeutic strategy.

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