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Clinical Drug Investigation
Published in: Clinical Drug Investigation 10/2016

01-10-2016 | Systematic Review

Treatment of Progressive Multifocal Leukoencephalopathy With Mirtazapine

Authors: Yvan Jamilloux, Sébastien Kerever, Tristan Ferry, Christiane Broussolle, Jérôme Honnorat, Pascal Sève

Published in: Clinical Drug Investigation | Issue 10/2016

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Abstract

Background and Objectives

Progressive multifocal leukoencephalopathy (PML) is a rare, JC-virus-mediated, demyelinating disease with a high mortality rate. As no recommended treatment exists, mirtazapine, a potential blocker of virus entry into cells, has been empirically used.

Methods

We analysed existing data on mirtazapine’s efficacy to treat PML by systematically reviewing the literature since 2005, when it was first used.

Results

Searches in PubMed, EBSCO, SCOPUS and Google Scholar between January 2005 and December 2015, identified five cohort studies and 74 case reports. No statistically significant effect of mirtazapine on PML outcome was observed in the cohort studies. From studying the case reports, mortality rate for PML was associated with the underlying circumstances, such as an older age, the use of an immunosuppressant, or PML occurring in patients with a haematological malignancy or a transplant.

Conclusions

Except for natalizumab-associated PML, we did not highlight any potential benefit of mirtazapine on disease outcomes. Further interventional studies are needed to confirm that 5-HT2AR inhibition is relevant to treat PML.
Appendix
Available only for authorised users
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Metadata
Title
Treatment of Progressive Multifocal Leukoencephalopathy With Mirtazapine
Authors
Yvan Jamilloux
Sébastien Kerever
Tristan Ferry
Christiane Broussolle
Jérôme Honnorat
Pascal Sève
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Clinical Drug Investigation / Issue 10/2016
Print ISSN: 1173-2563
Electronic ISSN: 1179-1918
DOI
https://doi.org/10.1007/s40261-016-0433-8

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