Minimal supportive treatment in natalizumab-related PML in a MS patient
| Autor: | Laurent Kaiser, Frederik Barkhof, Ruxandra Iancu Ferfoglia, Patrice H. Lalive, Sven Haller, R. Du Pasquier, Claire Bridel |
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| Přispěvatelé: | Radiology and nuclear medicine, NCA - Neuroinflamation |
| Rok vydání: | 2015 |
| Předmět: |
Palliative care
JC virus medicine.disease_cause Antibodies Monoclonal Humanized/adverse effects/therapeutic use ddc:616.0757 Multiple Sclerosis Relapsing-Remitting/diagnosis/drug therapy Disability Evaluation Neurologic Examination/drug effects Natalizumab Immune system Immune reconstitution inflammatory syndrome parasitic diseases medicine Humans Leukoencephalopathy Progressive Multifocal/diagnosis/drug therapy ddc:616 biology business.industry Progressive multifocal leukoencephalopathy Palliative Care Middle Aged medicine.disease Magnetic Resonance Imaging ddc:616.8 Brain/drug effects/pathology Psychiatry and Mental health Diffusion Magnetic Resonance Imaging Monoclonal Immunology biology.protein Disease Progression Surgery Female Neurology (clinical) Antibody Immune Reconstitution Inflammatory Syndrome/chemically induced/diagnosis business medicine.drug Follow-Up Studies |
| Zdroj: | Journal of Neurology, Neurosurgery and Psychiatry, 86(3), 354-355. BMJ Publishing Group Lalive, P H, Bridel, C, Ferfoglia, R I, Kaiser, L, Du Pasquier, R, Barkhof, F & Haller, S 2015, ' Minimal supportive treatment in natalizumab-related PML in a MS patient ', Journal of Neurology, Neurosurgery and Psychiatry, vol. 86, no. 3, pp. 354-355 . https://doi.org/10.1136/jnnp-2014-308154 Journal of Neurology, Neurosurgery, and Psychiatry, Vol. 86, No 3 (2015) pp. 354-5 |
| ISSN: | 0022-3050 |
| DOI: | 10.1136/jnnp-2014-308154 |
| Popis: | Natalizumab (NTZ) is a recombinant humanised immunoglobulin G4 monoclonal antibody that selectively inhibits adhesion of α4-β1 receptor on the surface of lymphocytes and hinders circulating cells from leaving the vascular compartment of the brain.1 NTZ is associated with a risk of developing progressive multifocal leukoencephalopathy (PML), estimated at approximately 1/200 in JCV-positive patients after 24 months treatment duration.1 The overall survival rate is 71% in PML secondary to NTZ treatment, which is substantially better than the often-fatal course of PML in other immunosuppressed patients.2 This reflects the fact that immune reconstitution is more easily obtained in NTZ patient by treatment cessation.3 Immune reconstitution inflammatory syndrome (IRIS), characterised by contrast-enhancing MRI lesions with clinical deterioration, is observed in almost all PML patients after NTZ cessation.2 Plasma exchange (PLEX) is usually initiated after NTZ cessation to remove remaining circulating NTZ levels, which favours the immune reconstitution, whereas intravenous corticosteroids (CS) are given to suppress IRIS development.1 Nevertheless, the increased peripheral functional T-cell expansion following PLEX can be seen as an accelerator for IRIS, and the negative impact of CS on JCV-specific CD8 T cell response is also at risk of inhibiting the physiological immune response against the JC virus (JCV). ### Report of a case A patient was diagnosed with relapsing-remitting MS at the age of 46 years. Her JCV IgG serum status was positive 6 months after NTZ treatment initiation. After 22 infusions, she presented … |
| Databáze: | OpenAIRE |
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