Related Experiment Video
Updated: Aug 27, 2025
09:38
Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination
Published on: September 12, 2016
12.4K
Progressive Multifocal Leukoencephalopathy Treated by Immune Checkpoint Inhibitors
Xavier Boumaza1, Baptiste Bonneau2, Damien Roos-Weil3
1Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France.
Annals of Neurology
|September 24, 2022
Summary
Immune checkpoint inhibitors show limited real-world effectiveness for progressive multifocal leukoencephalopathy (PML), with high mortality and frequent immune reconstitution inflammatory syndrome (IRIS). Personalized treatment approaches are crucial for patients with PML.
Area of Science:
- Neuroimmunology
- Oncology
- Infectious Diseases
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare, often fatal demyelinating disease.
- Immune checkpoint inhibitors (ICIs) are increasingly used in oncology, raising questions about their safety and efficacy in patients with other conditions.
Purpose of the Study:
- To evaluate the real-world effectiveness and safety of ICIs as add-on therapy for patients with PML.
- To identify factors associated with survival in PML patients treated with ICIs.
Main Methods:
- A multicenter retrospective survey of 79 PML patients treated with ICIs.
- Analysis of one-year clinical outcomes and safety data.
- Logistic regression to identify predictors of 1-year survival.
Main Results:
- One-year survival was 51.9%.
- PML-immune reconstitution inflammatory syndrome (IRIS) occurred in 19% of patients.
- Contrast enhancement on MRI and decreasing JC polyomavirus DNA load in CSF were associated with survival.
Conclusions:
- Mortality remains high in PML patients treated with ICIs.
- Development of inflammatory features or PML-IRIS is common.
- ICI treatment for PML requires careful personalization based on individual patient characteristics.
Related Concept Videos
01:22Alzheimer's Disease: Treatment
248
Alzheimer's Disease (AD), a neurodegenerative disorder, is pathologically identified by amyloid plaques and neurofibrillary tangles composed of tau protein. AD pharmacotherapy aims to manage cognitive symptoms, delay disease progression, and treat behavioral symptoms. The treatment is primarily symptomatic and palliative, with no definitive disease-modifying therapy available. Cholinesterase inhibitors, including donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), are...
248
01:27Tumor Immunotherapy
643
Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
643
01:24Parkinson's Disease: Treatment
354
Neurodegenerative disorders, such as Parkinson's Disease (PD), involve the gradual and irreversible destruction of neurons in particular brain areas. These disorders exhibit standard features like proteinopathies, selective vulnerability of some neurons, and an interaction of intrinsic properties, genetics, and environmental influences in neural injury.
Parkinson's Disease is primarily a result of the loss of dopaminergic neurons in the substantia nigra pars compacta. The cornerstone of...
Parkinson's Disease is primarily a result of the loss of dopaminergic neurons in the substantia nigra pars compacta. The cornerstone of...
354
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
255
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
255
02:56Treatment Resistant Cancers
3.4K
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
3.4K
01:27Open Angle Glaucoma: Treatment
527
In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
Drugs such as carbonic anhydrase inhibitors, α2- and...
Drugs such as carbonic anhydrase inhibitors, α2- and...
527