Lipid‐specific immunoglobulin <scp>M</scp> bands in cerebrospinal fluid are associated with a reduced risk of developing progressive multifocal leukoencephalopathy during treatment with natalizumab

Villar, Luisa M.; Costa‐Frossard, Lucienne; Masterman, Thomas; Fernández, Óscar; Montalbán, Xavier; Casanova, Bonaventura; Izquierdo, Guillermo; Coret, Francisco; Tumani, Hayrettin; Sáiz, Albert; Arroyo, Rafael; Fink, Katharina; Leyva, Laura; Espejo, Carmen; Simó-Castelló, María; García-Sánchez, M. I.; Lauda, Florían; Llufriú, Sara; Álvarez‐Lafuente, Roberto; Olascoaga, Javier; Prada, Álvaro; Oterino, Agustı́n; Andrés, Clara de; Tintoré, Mar; Ramió-Torrentà, Lluı́s; Rodrı́guez-Martı́n, Eulalia; Picón, Carmen; Comabella, Manuel; Quintana, Ester; Agüera, Eduardo; Díaz, Santiago; Fernández‐Bolaños, Ricardo; García-Merino, J.A.; Landete, L; Menéndez-González, Manuel; Navarro, Laura; Pérez, Domingo; Sánchez-López, Fernando; Serrano-Castro, Pedro J.; Tuñón, Alberto Hidalgo; Espiño, Mercedes; Muriel, Alfonso; Bar‐Or, Amit; Álvarez‐Cermeño, José C.

doi:10.1002/ana.24345

Cited by 50 publications

(40 citation statements)

References 29 publications

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“…Use of serum and cerebrospinal fluid JCV antibody indices, measurement of L-selectin expressing CD4 T cells, and other methods may further refine risk stratification. [108][109][110][111] A JCV antibody index below 0.9 is associated with lower risk for PML and an index above 1.5 is associated with higher risk, 109 but observational studies found that natalizumab treatment was associated with increasing indices over time (0.091 units/year, or 13%) and high annual seroconversion rates (8.5-10.3%). 112 113 Alternative treatments should be considered for patients who seroconvert.…”

Section: Mitoxantronementioning

confidence: 99%

Disease modifying therapies for relapsing multiple sclerosis

Wingerchuk

Weinshenker

2016

BMJ

144

116

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Multiple sclerosis (MS) is a common, disabling, putatively autoimmune neurological disease with worldwide distribution. It typically begins as a relapsing disorder that later evolves to a secondary progressive phase. Inflammatory and neurodegenerative mechanisms seem to operate in both phases, but their relative contributions and interactions are incompletely understood. Disease modifying therapies (DMTs) approved for relapsing multiple sclerosis interfere with a variety of immunological mechanisms to reduce rates of relapse, accumulation of disease burden measured by magnetic resonance imaging (MRI), and decline in neurological function over the two to three year duration of typical randomized controlled trials. Benefits of longer duration of therapy on disability are less clear, as data beyond three years are largely limited to observational studies. However, current DMTs do not slow accrual of disability once progressive multiple sclerosis is established. This review summarizes the evidence about the use of approved DMTs and examines how to individualize treatment despite the absence of validated biomarkers to guide drug selection. Methods such as stratifying patients on the basis of estimated risk for future disability, weighing patient specific factors and preferences, and using objective outcomes to adjudicate treatment success are discussed. Emerging drug therapies and strategies are also reviewed.

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Section: Mitoxantronementioning

confidence: 99%

Disease modifying therapies for relapsing multiple sclerosis

Wingerchuk

Weinshenker

2016

BMJ

144

116

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“…Moreover, some studies suggested that CSF OCBs of the IgM isotype associate with (a) aggressive MS forms [18], (b) better responses to immunotherapies [19], (c) lower risks of developing progressive multifocal leukoencephalopathy in patients on natalizumab [20], and (d) higher probability of reaching EDSS scores of 3.0/4.0 10 years after onset [21]. The data are waiting for further confirmation and wider consensus before IgM OCB test enters routine clinico-laboratory practice [22].…”

Section: Multiple Sclerosis and Oligoclonal Bandsmentioning

confidence: 99%

Cerebrospinal fluid analysis and the determination of oligoclonal bands

Gastaldi

Zardini

Leante³

et al. 2017

Neurol Sci

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This document presents the guidelines for the cerebrospinal fluid (CSF) analysis and the determination of oligoclonal bands (OCBs) as pivotal tests in neuroin flammatory pathologies of the central nervous system. The guidelines have been developed following a consensus process built on questionnaire-based surveys, internet contacts, and discussions at workshops of the sponsoring Italian Association of Neuroimmunology (AINI) congresses. Essential clinical information on the pathologies in which the CSF analysis is indicated, and, particularly, on those characterized by the presence of OCBs in the intrathecal compartment, indications and limits of CSF analysis and OCB determination, instructions for result interpretation, and agreed laboratory protocols (Appendix) are

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“…Even for some time after the cessation of natalizumab, a certain risk of PML remains and pharmacovigilance should be continued [63,64]. There are increasing efforts to further refine PML risk stratification, especially for patients that convert to anti-JCV antibody positive status while on natalizumab, using antibody indices in serum and cerebrospinal fluid, as well as other approaches [65][66][67][68].…”

Section: Natalizumabmentioning

confidence: 99%

Advances in and Algorithms for the Treatment of Relapsing-Remitting Multiple Sclerosis

2016

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Treatment options in relapsing-remitting multiple sclerosis have increased considerably in recent years; currently, a dozen different preparations of diseasemodifying therapies are available and some more are expected to be marketed soon. For the treating neurologist this broad therapeutic repertoire not only greatly improves individualized management of the disease, but also makes choices more complex and difficult. A number of factors must be considered, including disease activity and severity, safety profile, and patient preference. We here discuss the currently existing options and suggest treatment algorithms for managing relapsing-remitting multiple sclerosis.

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Lipid‐specific immunoglobulin M bands in cerebrospinal fluid are associated with a reduced risk of developing progressive multifocal leukoencephalopathy during treatment with natalizumab

Abstract: The presence of IgM bands reflects a process that may diminish the risk of PML by counteracting the excess of immunosuppression that may occur during natalizumab therapy.

Cited by 50 publications

References 29 publications

Disease modifying therapies for relapsing multiple sclerosis

Disease modifying therapies for relapsing multiple sclerosis

Cerebrospinal fluid analysis and the determination of oligoclonal bands

Advances in and Algorithms for the Treatment of Relapsing-Remitting Multiple Sclerosis

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