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

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

Elisabeth Maillart  1 , Jean-Sebastien Vidal  1 , David Brassat  1 , Bruno Stankoff  1 , Agnès Fromont  1 , Jérôme de Sèze  1 , Frédéric Taithe  1 , Pierre Clavelou  1 , Bertrand Bourre  1 , Valérie Delvaux  1 , Audrey Rico  1 , Pierre Labauge  1 , Ayman Tourbah  1 , Christine Lebrun  1 , Jean Pelletier  1 , Thibault Moreau  1 , Céline Louapre  1 , Catherine Lubetzki  1 , Caroline Papeix  1
Affiliations

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

Elisabeth Maillart et al. Neurol Neuroimmunol Neuroinflamm. .

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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Figures

Figure 1
Figure 1. Timeline of subsequent MS treatments, after Nz-PML for each patient of the cohort
The zero on the x-axis represents the diagnosis of Nz-PML. Black line: washout period after natalizumab cessation without any MS disease-modifying therapy. Blue line: interferon β. Red line: glatiramer acetate. Peach line: dimethyl fumarate. Green line: fingolimod. Asterisk: one clinical relapse. Circle: new MS lesions on brain MRI. Cross: intolerance of the treatment. MS = multiple sclerosis; Nz-PML = natalizumab-related progressive multifocal leukoencephalopathy. Adapted from reference 6, with permission; © 2014 SAGE Publications.
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References

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