Natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: risk reduction, management and possibilities for subsequent immunoregulation

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Abstract

The risk of progressive multifocal leukoencephalopathy (PML) is one of the factors limiting the widespread use of natalizumab (NTZ). As a strategy for potentially reducing the frequency of the NTZ-associated PML, while maintaining the high therapy efficacy, in addition to the widely-used risk stratification strategy based on anti-JC virus antibody index and therapy duration, we propose the administration of NTZ with an extended dosing interval. Opinions vary on the effectiveness of plasmapharesis in confirmed cases of PML. The most challenging problem is how to manage patients, who develop PML, and what MS disease-modifying therapy should be considered for the subsequent use.

About the authors

Natalia V. Khachanova

Pirogov Russian National Research Medical University

Author for correspondence.
Email: voroba.nat@mail.ru
Russian Federation, Moscow

Alexey N. Boyko

Pirogov Russian National Research Medical University; Federal Center for Cerebrovascular Pathology and Stroke

Email: voroba.nat@mail.ru
Russian Federation, Moscow

Maria V. Shumilina

City Clinical Hospital No. 31

Email: voroba.nat@mail.ru
Russian Federation, St. Petersburg

Inna V. Smagina

Altai State Medical University

Email: voroba.nat@mail.ru
Russian Federation, Barnaul

Nadezhda A. Malkova

Novosibirsk State Medical University; State Novosibirsk Regional Clinical Hospital

Email: voroba.nat@mail.ru
Russian Federation, Novosibirsk

Stella A. Sivertseva

Health Unit «Neftyanik»

Email: voroba.nat@mail.ru
Russian Federation, Tyumen

Ekaterina V. Popova

Pirogov Russian National Research Medical University; City Clinical Hospital No. 24

Email: voroba.nat@mail.ru
Russian Federation, Moscow

Timur I. Khaibullin

Republican Clinical Neurological Center

Email: voroba.nat@mail.ru
Russian Federation, Kazan

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Copyright (c) 2019 Khachanova N.V., Boyko A.N., Shumilina M.V., Смагина I.V., Malkova N.A., Sivertseva S.A., Popova E.V., Khaibullin T.I.

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