Treating MS after surviving PML: Discrete strategies for rescue, remission, and recovery patient 1

Anadani, Nidhiben; Hyland, Megan; Cruz, Roberto Alejandro; Lisak, Robert P.; Costello, Kathleen; Major, Eugene O.; Jassam, Yasir; Meltzer, Ethan; Varkey, Thomas; Parsons, Matthew S.; Goodman, Andrew; Graves, Jennifer; Newsome, Scott D.; Zamvil, Scott S.; Frohman, Elliot M.; Frohman, Teresa C.

doi:10.1212/nxi.0000000000000929

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…Additional reports include use of teriflunomide, rituximab, and alemtuzumab. [14][15][16] No patient developed recurrent PML, but this has been reported in patients with HIV despite immune recovery. 17 DMT may be safe after natalizumabassociated PML, although conclusions are limited by selection bias and follow-up duration.…”

Section: Discussionmentioning

confidence: 99%

Escalation to Anti-CD20 Treatment for Multiple Sclerosis Following Natalizumab-Associated Progressive Multifocal Leukoencephalopathy

Wolf,

Corboy

2024

Neur Clin Pract

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ObjectivesDisease-modifying therapy (DMT) for multiple sclerosis (MS) after natalizumabassociated progressive multifocal leukoencephalopathy (PML) is controversial due to concern for recurrent PML. We describe DMT utilization for over a decade in a patient with MS who survived PML. Methods Case report. ResultsA 36-year-old woman was diagnosed with MS in 2002 and treated with interferon beta-1a until 2006, when she transitioned to natalizumab due to relapses. She presented in 2012 with 2 months of progressive cognitive and gait concerns and was diagnosed with PML by positive CSF JC virus testing with concordant clinical and MRI findings. She was treated with plasma exchange and then corticosteroids for PML immune reconstitution inflammatory syndrome before starting glatiramer acetate for DMT. She transitioned to dimethyl fumarate in 2013 after MS activity on MRI with negative CSF JC virus testing. Owing to worsening footdrop consistent with progression, she transitioned to ocrelizumab in 2017 and then to ofatumumab in 2020 due to logistics of medication administration. There has been no clinicoradiographic or CSF evidence of recurrent PML. DiscussionDMT selection is challenging for patients with MS who survive PML. We used an escalation approach extending to ocrelizumab and ofatumumab due to MS progression. Anti-CD20 DMTs are a high-efficacy option post-PML. Classification of EvidenceThis provides Class IV evidence. It is a single observational study without controls.

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Section: Discussionmentioning

confidence: 99%

Escalation to Anti-CD20 Treatment for Multiple Sclerosis Following Natalizumab-Associated Progressive Multifocal Leukoencephalopathy

Wolf,

Corboy

2024

Neur Clin Pract

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“…В настоящее время нет единого мнения о тактике дальнейшего ведения пациентов с РС, перенесших НТЗ-ПМЛ. В литературе имеется ограниченное количество данных об использовании ПИТРС 1-й линии [16,17] и МАТ [18]. В представленном случае 2 от терапии ПИТРС воздержались, продолжается тщательное наблюдение пациентки.…”

Section: заключениеunclassified

Progressive multifocal leukoencephalopathy in the clinical practice of a neurologist. Case report

Belova,

Kotov

2024

Consilium Medicum

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Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection with severe brain damage caused by the JC-virus, against the background of immunosuppressive conditions. The diagnosis of PML is complex and includes: the clinical picture, neuroimaging data, the presence of JC-virus DNA in samples of cerebrospinal fluid or brain tissue. HIV-associated PML is difficult to diagnose. In patients with multiple sclerosis, an increase in the incidence of PML is associated with the use of natalizumab. Increasing alertness towards the development and detection of PML makes it possible to achieve a favorable outcome.

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“…Each field is consistently color coded throughout as defined in the figure legend. 16 Glossary DMT = disease-modifying therapy; MS = multiple sclerosis; NMOSD = neuromyelitis optica spectrum disorder; RRMS = relapsing-remitting MS; S-1-P = sphingosine-1-phosphate; SPMS = secondary progressive MS; UTI = urinary tract infection.…”

Section: Figure 1 Chronological Heat Mapmentioning

confidence: 99%

Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder

Goldschmidt

Galetta

Lisak

et al. 2023

Neurol Neuroimmunol Neuroinflamm

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A woman presented at age 18 years with partial myelitis and diplopia and experienced multiple subsequent relapses. Her MRI demonstrated T2 abnormalities characteristic of multiple sclerosis (MS) (white matter ovoid lesions and Dawson fingers), and CSF demonstrated an elevated IgG index and oligoclonal bands restricted to the CSF. Diagnosed with clinically definite relapsing-remitting MS, she was treated with various MS disease-modifying therapies and eventually began experiencing secondary progression. At age 57 years, she developed an acute longitudinally extensive transverse myelitis and was found to have AQP4 antibodies by cell-based assay. Our analysis of the clinical course, radiographic findings, molecular diagnostic methods, and treatment response characteristics support the hypothesis that our patient most likely had 2 CNS inflammatory disorders: MS, which manifested as a teenager, and neuromyelitis optica spectrum disorder, which evolved in her sixth decade of life. This case emphasizes a key principle in neurology practice, which is to reconsider whether the original working diagnosis remains tenable, especially when confronted with evidence (clinical and/or paraclinical) that raises the possibility of a distinctively different disorder.

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Treating MS after surviving PML: Discrete strategies for rescue, remission, and recovery patient 1

Cited by 6 publications

References 13 publications

Escalation to Anti-CD20 Treatment for Multiple Sclerosis Following Natalizumab-Associated Progressive Multifocal Leukoencephalopathy

Escalation to Anti-CD20 Treatment for Multiple Sclerosis Following Natalizumab-Associated Progressive Multifocal Leukoencephalopathy

Progressive multifocal leukoencephalopathy in the clinical practice of a neurologist. Case report

Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder

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