Natalizumab-related progressive multifocal leukoencephalopathy in Greece

Dimos D Mitsikostas; Vasileios Mastorodemos; Minas Tsagournizakis; Antonios Kodounis; Antonios Tsagkaropoulos; Spyridon Konitsiotis; Panagiotis Toulas; Alexandros Papadimitriou; Dimitra Papadimitriou; Antonios Tavernarakis; Dimitrios Papadopoulos

doi:10.1016/j.msard.2013.08.006

Natalizumab-related progressive multifocal leukoencephalopathy in Greece

Mult Scler Relat Disord. 2014 Mar;3(2):203-10. doi: 10.1016/j.msard.2013.08.006. Epub 2013 Sep 24.

Affiliations

¹ Neurology Department, Athens Naval Hospital, 40 Deinokratous Street, 77A Vasilissis Sofias Avenue, 11521 Athens, Greece. Electronic address: [email protected].
² Neurology Department, Heraklion University Hospital, Voutes, 71110 Heraklion, Crete, Greece.
³ Neurology Department, 251 General Airforce Hospital, Kanellopoulou 3, 11525 Athens, Greece.
⁴ Neurology Department, University of Ioannina Medical School, Ioannina, Greece.
⁵ Radiology Department, Encephalos-EUROMEDICA, Rizariou 3, Halandri, 15233 Athens, Greece.
⁶ Neurology Department, Henry Dunant Hospital, Mesogeion 107, 11526 Athens, Greece.
⁷ Neurology Department, Evangelismos General Hospital, Ipsilantou 45-47, 10676 Athens, Greece.
⁸ Neurology Department, Athens Naval Hospital, 40 Deinokratous Street, 77A Vasilissis Sofias Avenue, 11521 Athens, Greece; Neurology Department, Evangelismos General Hospital, Ipsilantou 45-47, 10676 Athens, Greece.

PMID: 25878008
DOI: 10.1016/j.msard.2013.08.006

Abstract

Background & objectives: Progressive multifocal leukoencephalopathy (PML) may complicate natalizumab treatment in multiple sclerosis patients. We sought to characterize the clinical and laboratory features of natalizumab-related PML (NR-PML) cases from Greece.

Methods: Pharmaceutical industry, national drug authorities and all neurology departments within the Greek territory were asked to provide data for cases of NR-PML until October 2012. Collected cases were classified according to their level of diagnostic certainty using the five-level system introduced by Mentzer et al. (2012).

Results: Thirteen NR-PML cases were identified by the neurology departments. Data were provided for only 9 cases. PML manifestations appeared after a median number of 40 (21-52) natalizumab infusions. All but two patients were treated with plasma exchange and some were treated adjunctively with mirtazapine while the others were treated with mefloquine. IRIS developed in 6 cases after a median time of 6 (2-10) weeks from PML presentation and were treated with different regimens of corticosteroids. PML was fatal in 3 cases. The median EDSS after a median follow-up time of 12 (8-23) months in the surviving cases was 4.75 (2-8.5).

Conclusions: Outcomes for collected NR-PML cases varied from death to returning to baseline. Close surveillance is essential for early diagnosis and treatment of NR-PML patients.

Keywords: Adverse events; Immune reconstitution inflammatory syndrome; Multiple sclerosis; Natalizumab; Progressive multifocal leukoencephalopathy; Treatment.