Natalizumab treatment for multiple sclerosis: updates and considerations for safer treatment in JCV positive patients

Author(s)

da Silva Nali, Luiz Henrique ^[1] ; Moraes, Lenira ^[2] ; Domingues Fink, Maria Cristina ^[1] ; Callegaro, Dagoberto ^[2] ; Romano, Camila Malta ^[1] ; Penalva de Oliveira, Augusto Cesar ^[3]

Affiliation

^[1] Univ Sao Paulo, Fac Med, Inst Med Trop Sao Paulo, Dept Molestias Infecciosas & Parasitarias, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Hosp Clin, Sao Paulo - Brazil

^[3] Inst Infectol Emilio Ribas, Sao Paulo - Brazil

• Document type: Journal article
• Source: Arquivos de Neuro-Psiquiatria; v. 72, n. 12, p. 960-965, DEC 2014.
• Web of Science Citations: 7

Abstract

Natalizumab is currently one of the best options for treatment of patients with Multiple Sclerosis who have failed traditional prior therapies. However, prolonged use, prior immunosuppressive therapy and anti-JCV antibody status have been associated with increased risk of developing progressive multifocal leukoencephalopathy (PML). The evaluation of these conditions has been used to estimate risks of PML in these patients, and distinct (sometimes extreme) approaches are used to avoid the PML onset. At this time, the biggest issue facing the use of Natalizumab is how to get a balance between the risks and the benefits of the treatment. Hence, strategies for monitor JCV-positive patients undergoing Natalizumab treatment are deeply necessary. To illustrate it, we monitored JCV/DNA in blood and urine of a patient receiving Natalizumab for 12 months. We also bring to discussion the effectiveness of the current methods used for risk evaluation, and the real implications of viral reactivation. (AU)

• FAPESP's process: 10/10619-0 - Investigation of latent viruses in patients with multiple sclerosis under treatment with Natalizumab
• Grantee: Camila Malta Romano
• Support type: Regular Research Grants