Concerns about the risk of progressive multifocal leukoencephalopathy (PML) caused
by the John Cunningham (JC) virus are foremost in the minds of neurologists who manage
patients with multiple sclerosis (MS). Prior to the introduction of natalizumab in
2007, only sporadic cases of MS-PML were observed. They had been treated previously
with strong immune suppressant medications like cyclophosphamide (
Tan et al., 2011
). Since 2007, the number of cases of MS-PML has topped 700, mostly related to the
worldwide use of natalizumab, but also reflecting a handful of patients using popular
medications including rituximab (
Bohra et al., 2017
), fingolimod (
Yoshii et al., 2017
), and dimethyl fumarate (
Gieselbach et al., 2017
). After six years of careful study, the four strongest risk factors that predict
PML in the MS population are 1. Use of prior immune suppressive medications, 2. Exposure
and immune response to the JC virus, 3. Duration of treatment with natalizumab (
Biogen, 2017
) and 4. Age. It is difficult to tease out the risk of PML posed by any individual
treatment because most MS patients with PML have been on multiple medications. The
calculated incidence of PML from natalizumab has now increased to 13 per 1,000 among
those with seropositive JC virus antibody titers and prior immune suppressive exposure
(
Biogen, 2017
).Keywords
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References
Biogen , 2017 . TYSABRI® (natalizumab): PML Incidence in Patients Receiving TYSABRI. Biogen.
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