2 research outputs found
Natalizumab-related progressive multifocal leukoencephalopathy in multiple sclerosis: Findings from an Italian independent registry
No evidence of beneficial effects of plasmapheresis in natalizumab-associated PML
Objective: To examine retrospectively the effects of plasmapheresis (PLEX) on the survival and
clinical outcomes of patients with multiple sclerosis (MS) and natalizumab (NTZ)–associated
progressive multifocal leukoencephalopathy (PML).
Methods: The medical literature was searched for the terms natalizumab and progressive multifocal
leukoencephalopathy. A total of 193 international and 34 Italian NTZ-PML cases were
included. Clinical outcome was determined by comparing the patients’ clinical status at PML
diagnosis with status after PML resolution. The effects on survival and clinical outcome of PLEX,
sex, age, country, pre-PML Expanded Disability Status Scale score, NTZ infusion number, prior
immunosuppressant exposure, PML symptoms, PML lesion location at diagnosis, CSF JC virus
status and copies, additional PML treatments and steroids, and PML immune reconstitution
inflammatory syndrome (IRIS) development were investigated with both univariate and multivariate
analyses.
Results: A total of 219 NTZ-PML cases were analyzed, and 184 (84%) underwent PLEX, which did
not reduce the mortality risk or the likelihood of poor vs favorable outcomes. Country was predictive
of mortality and poor outcome, while PML-IRIS development was predictive of poor outcome.
Conclusions: PLEX did not improve the survival or clinical outcomes of Italian or international patients
with MS and NTZ-PML, suggesting that this treatment should be performed cautiously in
the future.
Classification of evidence: This study provides Class III evidence that for patients with NTZ-PML,
PLEX does not improve survival. The study lacks the statistical precision to exclude an important
benefit or harm of PLEX