JCV detection in multiple sclerosis patients treated with natalizumab

• Published in: Journal of neurology 2010-06, Vol.257 (6), p.954-958
• Main Authors: Sadiq, Saud A., Puccio, Lauren M., Brydon, Edward W. A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Biological and medical sciences; BK virus; BK Virus - genetics; BK Virus - isolation & purification; DNA, Viral - blood; DNA, Viral - cerebrospinal fluid; FDA approval; Female; Follow-Up Studies; Humans; Immunologic Factors - adverse effects; Immunologic Factors - therapeutic use; JC virus; JC Virus - genetics; JC Virus - isolation & purification; Leukoencephalopathy, Progressive Multifocal - virology; Magnetic resonance imaging; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Multiple sclerosis; Multiple Sclerosis - complications; Multiple Sclerosis - drug therapy; Multiple Sclerosis - virology; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Multiple Sclerosis, Chronic Progressive - complications; Multiple Sclerosis, Chronic Progressive - drug therapy; Multiple Sclerosis, Chronic Progressive - virology; Multiple Sclerosis, Relapsing-Remitting - complications; Multiple Sclerosis, Relapsing-Remitting - drug therapy; Multiple Sclerosis, Relapsing-Remitting - virology; Natalizumab; Neurology; Neuroradiology; Neurosciences; Original Communication; Patients; Plasma; Polyomavirus; Polyomavirus Infections - complications; Polyomavirus Infections - diagnosis; Polyomavirus Infections - virology; Prospective Studies; Tumor Virus Infections - complications; Tumor Virus Infections - diagnosis; Tumor Virus Infections - virology; Viral infections
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-009-5444-4

Natalizumab therapy is associated with an increased risk of progressive multifocal leukoencephalopathy (PML). Because the prognosis of established PML is uniformly dismal, identification of highly susceptible patients to the disease may improve outcomes. We wanted to investigate whether serial plasma and cerebrospinal fluid (CSF) screening for polyomavirus would identify patients with laboratory evidence of viral infection prior to the development of clinical PML. Two hundred MS patients had pre-treatment CSF/plasma screening for JC virus (JCV) and BK virus (BKV) DNA, and thereafter every six treatments of natalizumab. In all positive patients treatment is stopped (due to potential risk of PML), they have follow-up clinical examinations and plasma/CSF JCV/BKV tests until all evaluations are normal. No patient developed clinical evidence of PML. Eight of the 200 patients had detectable JCV or BKV DNA. Five patients were positive for BKV DNA in the CSF and three patients were positive for JCV DNA (one in plasma, two in CSF). After cessation of natalizumab treatment, all patients converted to undetectable viral DNA. Screening for JCV in CSF in natalizumab-treated patients could help identify those at heightened risk for developing PML and discontinuing treatment in these patients may abort development of the clinical illness.