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Updated: Apr 3, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Risk of progressive multifocal leukoencephalopathy in patients with multiple sclerosis
1a Creighton University, Pharmacy Practice and Neurology , Omaha, USA MicheleFaulkner@creighton.edu.
Introduction:
Multiple sclerosis (MS) is an autoimmune disorder that is characterized by inflammatory processes that lead to the destruction of myelin. Recently, several medications for MS that possess immune suppressing characteristics have been developed. As a consequence, cases of progressive multifocal leukoencephalopathy (PML) have been identified in MS patients. PML is potentially fatal, and specific strategies to minimize risk must be undertaken during therapy.
Areas Covered:
A Medline search was performed to gather information about medications used to treat MS to assess the risk of PML with each. Specific risk factors for infection development are discussed and monitoring approaches are outlined.
Expert Opinion:
Several medications have been associated with PML in MS patients, including natalizumab, fingolimod and dimethyl fumarate. Alemtuzumab and rituximab have been linked to cases of PML in other disease states. Consideration must be given to balancing efficacy with the potential for serious side effects, including PML. The severity of MS presentation may justify the use of a higher-risk medication at the outset. Increased diligence in obtaining MRIs and antibody status is essential as data demonstrate early identification of PML results in better outcomes. Lymphopenia and antibody index also appear to be reasonable factors to consider when choosing therapy.
Insights
Certain multiple sclerosis (MS) drugs increase the risk of progressive multifocal leukoencephalopathy (PML), a serious brain infection. Careful monitoring and risk assessment are crucial when selecting MS therapies to ensure patient safety.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Multiple sclerosis (MS) involves autoimmune-driven myelin destruction.
- New MS therapies with immunosuppressive properties have emerged.
- Progressive multifocal leukoencephalopathy (PML) is a rare but fatal opportunistic infection linked to MS treatments.
Purpose of the Study:
- To review medications used for MS and their association with PML risk.
- To discuss risk factors and monitoring strategies for PML in MS patients.
Main Methods:
- Conducted a Medline search for MS medications and PML incidence.
- Analyzed data on specific drugs, risk factors, and monitoring protocols.
Main Results:
- Natalizumab, fingolimod, and dimethyl fumarate are associated with PML in MS.
- Alemtuzumab and rituximab have been linked to PML in other conditions.
- Early identification of PML through MRI and antibody status is critical for better outcomes.
Conclusions:
- Balancing treatment efficacy with PML risk is essential for MS management.
- Factors like disease severity, lymphopenia, and antibody index inform therapy choices.
- Vigilant monitoring and risk stratification are key to minimizing PML incidence in MS patients.
