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Treatment-Related Progressive Multifocal Leukoencephalopathy in Multiple Sclerosis: A Comprehensive Review of Current

Emanuele D'Amico1, Aurora Zanghì1, Carmela Leone1

  • 1Multiple Sclerosis Center, Policlinico G. Rodolico, Via Santa Sofia, 78, Catania, 95123, Italy.

Drug Safety
|October 4, 2016
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML), a rare brain infection, is linked to multiple sclerosis (MS) treatments. Understanding JCV reactivation risks and patient stratification is crucial for managing these serious side effects.

Area of Science:

  • Neuroimmunology
  • Infectious Diseases
  • Central Nervous System Disorders

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, opportunistic central nervous system infection caused by the John Cunningham virus (JCV).
  • PML is associated with therapeutic immunosuppression in multiple sclerosis (MS) patients, with over 600 cases linked to natalizumab.
  • Cases of PML have also been reported with fingolimod and dimethyl fumarate, highlighting risks with newer MS therapies.

Purpose of the Study:

  • To review the current understanding of PML pathogenesis in the context of MS treatment.
  • To discuss patient risk stratification strategies for PML development.
  • To emphasize the importance of understanding side effects of disease-modifying therapies for MS.

Main Methods:

  • Literature review of PML cases associated with MS therapies.
  • Analysis of identified risk factors for PML development.
  • Discussion of diagnostic and risk stratification tools.

Main Results:

  • Multiple sclerosis treatments, particularly natalizumab, fingolimod, and dimethyl fumarate, carry a risk of PML due to immunosuppression and JCV reactivation.
  • Factors increasing PML risk include positive JCV serology, natalizumab use >2 years, and prior immunosuppressant use.
  • Despite risk stratification tools, the incidence of PML with natalizumab has not decreased.

Conclusions:

  • The evolving landscape of MS treatment necessitates a thorough understanding of the risks associated with disease-modifying therapies, including PML.
  • Effective patient risk stratification and awareness of JCV reactivation are critical for managing PML in MS patients.
  • Optimal decision-making in MS management requires comprehensive knowledge of treatment-related side effects.

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