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Article

Advances in the management of PML: Focus on natalizumab

Robert Fox, MD
Cleveland Clinic Journal of Medicine November 2011, 78 (11 suppl 2) S33-S37; DOI: https://doi.org/10.3949/ccjm.78.s2.08
Robert Fox
Staff Neurologist and Medical Director, Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH
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ABSTRACT

Progressive multifocal leukoencephalopathy (PML), a rare opportunistic infection of the central nervous system, occurs mainly in the setting of broad-based and selective immunosuppression. The immunomodulatory agent most often implicated in the development of PML is the monoclonal antibody natalizumab. Management of PML begins with risk stratification. Factors that predict the risk of PML are JC virus (JCV) antibody status, history of chemotherapy use, and cumulative exposure to natalizumab. The risk of natalizumab-related PML increases up to a duration of 36 months of therapy, after which the risk appears to level off. If suspicious for PML, the use of a sensitive JCV polymerase chain reaction assay permits early diagnosis. Immune reconstitution represents the mainstay of treatment for PML. With rapid reversal of immunosuppression followed by immunologic recovery, almost all patients suffer clinical deterioration termed immune reconstitution inflammatory syndrome (IRIS). High-dose corticosteroids are often recommended if a clinical and imaging syndrome resembling IRIS develops after immune restoration.

  • © 2011 The Cleveland Clinic Foundation. All Rights Reserved.
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Cleveland Clinic Journal of Medicine: 78 (11 suppl 2)
Cleveland Clinic Journal of Medicine
Vol. 78, Issue 11 suppl 2
1 Nov 2011
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Advances in the management of PML: Focus on natalizumab
Robert Fox
Cleveland Clinic Journal of Medicine Nov 2011, 78 (11 suppl 2) S33-S37; DOI: 10.3949/ccjm.78.s2.08

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Advances in the management of PML: Focus on natalizumab
Robert Fox
Cleveland Clinic Journal of Medicine Nov 2011, 78 (11 suppl 2) S33-S37; DOI: 10.3949/ccjm.78.s2.08
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