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Treatment of Progressive Multifocal Leukoencephalopathy With Mirtazapine
Yvan Jamilloux1, Sébastien Kerever2,3,4, Tristan Ferry5
1Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France. yvanjamilloux@hotmail.com.
Background And Objectives:
Progressive multifocal leukoencephalopathy (PML) is a rare, JC-virus-mediated, demyelinating disease with a high mortality rate. As no recommended treatment exists, mirtazapine, a potential blocker of virus entry into cells, has been empirically used.
Methods:
We analysed existing data on mirtazapine's efficacy to treat PML by systematically reviewing the literature since 2005, when it was first used.
Results:
Searches in PubMed, EBSCO, SCOPUS and Google Scholar between January 2005 and December 2015, identified five cohort studies and 74 case reports. No statistically significant effect of mirtazapine on PML outcome was observed in the cohort studies. From studying the case reports, mortality rate for PML was associated with the underlying circumstances, such as an older age, the use of an immunosuppressant, or PML occurring in patients with a haematological malignancy or a transplant.
Conclusions:
Except for natalizumab-associated PML, we did not highlight any potential benefit of mirtazapine on disease outcomes. Further interventional studies are needed to confirm that 5-HT2AR inhibition is relevant to treat PML.
Insights
Mirtazapine shows no significant benefit for treating progressive multifocal leukoencephalopathy (PML), a rare viral brain disease. Further research is needed to explore its potential role in specific cases, like natalizumab-associated PML.
Area of Science:
- Neurology
- Virology
- Immunology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare, fatal demyelinating disease caused by the JC virus.
- Currently, no definitive treatment is recommended for PML.
- Mirtazapine, a potential inhibitor of viral entry, has been used empirically.
Purpose of the Study:
- To systematically review the literature on mirtazapine's efficacy in treating PML.
- To evaluate the impact of mirtazapine on PML outcomes based on existing studies.
Main Methods:
- Systematic literature review of studies published from January 2005 to December 2015.
- Analysis of five cohort studies and 74 case reports identified through major scientific databases.
- Assessment of PML outcomes in relation to mirtazapine treatment and patient-specific factors.
Main Results:
- Cohort studies found no statistically significant effect of mirtazapine on PML outcomes.
- Case reports indicated that mortality in PML is associated with factors like advanced age, immunosuppression, hematological malignancy, or transplant history.
- No clear benefit of mirtazapine was observed, except possibly in natalizumab-associated PML.
Conclusions:
- Mirtazapine does not appear to improve outcomes for most cases of PML.
- Further interventional studies are required to determine if 5-HT2AR inhibition is a viable treatment strategy for PML.
- The underlying conditions of PML patients significantly influence mortality rates.
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