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Neurological Sciences
Published in: Neurological Sciences 10/2019

01-10-2019 | Multiple Sclerosis | Original Article

Four cases of natalizumab-related PML: a less severe course in extended interval dosing?

Authors: Cristina Scarpazza, Nicola De Rossi, Giulietta Tabiadon, Maria Vittoria Turrini, Simonetta Gerevini, Ruggero Capra

Published in: Neurological Sciences | Issue 10/2019

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Abstract

Background

Progressive multifocal leukoencephalopathy (PML) is a severe adverse event of natalizumab (NTZ). The administration of NTZ with extended interval dosing (EID) has been proposed as a strategy to potentially reduce the incidence of PML while maintaining its therapeutic efficacy.

Methods

In the current paper, we describe 4 cases of NTZ-PML in EID included in the Italian PML cohort.

Results

The patients developed PML after at least 38 NTZ infusions. Their John Cunningham virus (JCv) index was > 1.5, and patients had not previously used immunosuppressant. Two patients were asymptomatic at PML onset, while two had mild motor impairment of the right hand and anomia, respectively. All of them had undetectable viral load but one (37 JCv copies/ml). In all patients, MRI revealed unilobar lesions with deferred contrast enhancement suggestive of immune reconstitution. The clinical course ended with a favorable clinical outcome (ΔEDSS up to 1).

Conclusions

Although PML in EID seems to occur less frequently than in conventional dosing regimen, strict monitoring of high-risk patients contributed to the indolent course observed in the four described cases, characterized by a prolonged pre-symptomatic phase, paucisymptomatic onset, low JCv load, less severe functional impairment during immune reconstitution, and a mild disability burden.
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Metadata
Title
Four cases of natalizumab-related PML: a less severe course in extended interval dosing?
Authors
Cristina Scarpazza
Nicola De Rossi
Giulietta Tabiadon
Maria Vittoria Turrini
Simonetta Gerevini
Ruggero Capra
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Neurological Sciences / Issue 10/2019
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-019-03959-4

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