New Algorithms Improving PML Risk Stratification in MS Patients Treated With Natalizumab

• Published in: Frontiers in neurology 2020-12, Vol.11, p.579438-579438
• Main Authors: Toboso, Inmaculada, Tejeda-Velarde, Amalia, Alvarez-Lafuente, Roberto, Arroyo, Rafael, Hegen, Harald, Deisenhammer, Florian, Sainz de la Maza, Susana, Alvarez-Cermeño, José C, Izquierdo, Guillermo, Paramo, Dolores, Oliva, Pedro, Casanova, Bonaventura, Agüera-Morales, Eduardo, Franciotta, Diego, Gastaldi, Matteo, Fernández, Oscar, Urbaneja, Patricia, Garcia-Dominguez, José M, Romero, Fernando, Laroni, Alicia, Uccelli, Antonio, Perez-Sempere, Angel, Saiz, Albert, Blanco, Yolanda, Galimberti, Daniela, Scarpini, Elio, Espejo, Carmen, Montalban, Xavier, Rasche, Ludwig, Paul, Friedemann, González, Inés, Álvarez, Elena, Ramo, Cristina, Caminero, Ana B, Aladro, Yolanda, Calles, Carmen, Eguía, Pablo, Belenguer-Benavides, Antonio, Ramió-Torrentà, Lluis, Quintana, Ester, Martínez-Rodríguez, José E, Oterino, Agustín, López de Silanes, Carlos, Casanova, Luis I, Landete, Lamberto, Frederiksen, Jette, Bsteh, Gabriel, Mulero, Patricia, Comabella, Manuel, Hernández, Miguel A, Espiño, Mercedes, Prieto, José M, Pérez, Domingo, Otano, María, Padilla, Francisco, García-Merino, Juan A, Navarro, Laura, Muriel, Alfonso, Frossard, Lucienne Costa, Villar, Luisa M
• Format: Article
• Language: English
• Subjects: biomarkers; demyelinating diseases; disease modifying treatments; multiple sclerosis; natalizumab; Neurology; progressive multifocal leucoencephalopathy
• ISSN: 1664-2295; 1664-2295
• DOI: 10.3389/fneur.2020.579438

We assessed the role of age and disease activity as new factors contributing to establish the risk of progressive multifocal leucoencephalopathy in multiple sclerosis patients treated with natalizumab in 36 University Hospitals in Europe. We performed the study in 1,307 multiple sclerosis patients (70.8% anti-John Cunninghan virus positive antibodies) treated with natalizumab for a median time of 3.28 years. Epidemiological, clinical, and laboratory variables were collected. Lipid-specific IgM oligoclonal band status was available in 277 patients. Factors associated with progressive multifocal leucoencephalopathy onset were explored by uni- and multivariate logistic regression. Thirty-five patients developed progressive multifocal leucoencephalopathy. The multivariate analysis identified anti-John Cunninghan virus antibody indices and relapse rate as the best predictors for the onset of this serious opportunistic infection in the whole cohort. They allowed to stratify progressive multifocal leucoencephalopathy risk before natalizumab initiation in individual patients [area under the curve (AUC) = 0.85]. The risk ranged from