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Outcome and survival of asymptomatic PML in natalizumab-treated MS patients

OBJECTIVE: As of 3 September 2013, 399 cases of natalizumab-associated progressive multifocal leukoencephalopathy (PML) were confirmed in multiple sclerosis (MS) patients. We evaluated outcomes of natalizumab-treated MS patients who were asymptomatic at PML diagnosis. METHODS: Analyses included data...

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Autores principales: Dong-Si, Tuan, Richman, Sandra, Wattjes, Mike P, Wenten, Made, Gheuens, Sarah, Philip, Jeffrey, Datta, Shoibal, McIninch, James, Bozic, Carmen, Bloomgren, Gary, Richert, Nancy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BlackWell Publishing Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241803/
https://www.ncbi.nlm.nih.gov/pubmed/25493267
http://dx.doi.org/10.1002/acn3.114
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author Dong-Si, Tuan
Richman, Sandra
Wattjes, Mike P
Wenten, Made
Gheuens, Sarah
Philip, Jeffrey
Datta, Shoibal
McIninch, James
Bozic, Carmen
Bloomgren, Gary
Richert, Nancy
author_facet Dong-Si, Tuan
Richman, Sandra
Wattjes, Mike P
Wenten, Made
Gheuens, Sarah
Philip, Jeffrey
Datta, Shoibal
McIninch, James
Bozic, Carmen
Bloomgren, Gary
Richert, Nancy
author_sort Dong-Si, Tuan
collection PubMed
description OBJECTIVE: As of 3 September 2013, 399 cases of natalizumab-associated progressive multifocal leukoencephalopathy (PML) were confirmed in multiple sclerosis (MS) patients. We evaluated outcomes of natalizumab-treated MS patients who were asymptomatic at PML diagnosis. METHODS: Analyses included data available as of 5 June 2013. Asymptomatic patients diagnosed with PML by magnetic resonance imaging (MRI) findings and JC virus DNA detection in the central nervous system were compared with patients presenting with symptoms at diagnosis. Demographics, MRI, and survival over 12 months were analyzed. Expanded Disability Status Scale (EDSS) and Karnofsky Performance Scale (KPS) scores were recorded pre-PML, at diagnosis, and at 6 and 12 months post-diagnosis. RESULTS: A total of 372 PML cases were analyzed; 30 patients were asymptomatic and 342 were symptomatic at PML diagnosis. Classifications of PML lesions on MRI in asymptomatic versus symptomatic patients were unilobar in 68% versus 37%, multilobar in 21% versus 24%, and widespread in 11% versus 40%. In both groups with unilobar lesions, frontal lobe lesions predominated. Prior to PML, mean EDSS and KPS scores were similar for asymptomatic and symptomatic patients. At diagnosis, mean EDSS score was significantly lower for asymptomatic patients (4.1; n = 11) than for symptomatic patients (5.4; n = 193; P = 0.038). Six months after PML diagnosis, asymptomatic patients had less functional disability than symptomatic patients. As of 5 June 2013, 96.7% of asymptomatic patients and 75.4% of symptomatic patients were alive. INTERPRETATION: PML patients asymptomatic at diagnosis had better survival and less functional disability than those who were symptomatic at diagnosis.
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spelling pubmed-42418032014-12-09 Outcome and survival of asymptomatic PML in natalizumab-treated MS patients Dong-Si, Tuan Richman, Sandra Wattjes, Mike P Wenten, Made Gheuens, Sarah Philip, Jeffrey Datta, Shoibal McIninch, James Bozic, Carmen Bloomgren, Gary Richert, Nancy Ann Clin Transl Neurol Research Articles OBJECTIVE: As of 3 September 2013, 399 cases of natalizumab-associated progressive multifocal leukoencephalopathy (PML) were confirmed in multiple sclerosis (MS) patients. We evaluated outcomes of natalizumab-treated MS patients who were asymptomatic at PML diagnosis. METHODS: Analyses included data available as of 5 June 2013. Asymptomatic patients diagnosed with PML by magnetic resonance imaging (MRI) findings and JC virus DNA detection in the central nervous system were compared with patients presenting with symptoms at diagnosis. Demographics, MRI, and survival over 12 months were analyzed. Expanded Disability Status Scale (EDSS) and Karnofsky Performance Scale (KPS) scores were recorded pre-PML, at diagnosis, and at 6 and 12 months post-diagnosis. RESULTS: A total of 372 PML cases were analyzed; 30 patients were asymptomatic and 342 were symptomatic at PML diagnosis. Classifications of PML lesions on MRI in asymptomatic versus symptomatic patients were unilobar in 68% versus 37%, multilobar in 21% versus 24%, and widespread in 11% versus 40%. In both groups with unilobar lesions, frontal lobe lesions predominated. Prior to PML, mean EDSS and KPS scores were similar for asymptomatic and symptomatic patients. At diagnosis, mean EDSS score was significantly lower for asymptomatic patients (4.1; n = 11) than for symptomatic patients (5.4; n = 193; P = 0.038). Six months after PML diagnosis, asymptomatic patients had less functional disability than symptomatic patients. As of 5 June 2013, 96.7% of asymptomatic patients and 75.4% of symptomatic patients were alive. INTERPRETATION: PML patients asymptomatic at diagnosis had better survival and less functional disability than those who were symptomatic at diagnosis. BlackWell Publishing Ltd 2014-10 2014-10-09 /pmc/articles/PMC4241803/ /pubmed/25493267 http://dx.doi.org/10.1002/acn3.114 Text en © 2014 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc on behalf of American Neurological Association. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
spellingShingle Research Articles
Dong-Si, Tuan
Richman, Sandra
Wattjes, Mike P
Wenten, Made
Gheuens, Sarah
Philip, Jeffrey
Datta, Shoibal
McIninch, James
Bozic, Carmen
Bloomgren, Gary
Richert, Nancy
Outcome and survival of asymptomatic PML in natalizumab-treated MS patients
title Outcome and survival of asymptomatic PML in natalizumab-treated MS patients
title_full Outcome and survival of asymptomatic PML in natalizumab-treated MS patients
title_fullStr Outcome and survival of asymptomatic PML in natalizumab-treated MS patients
title_full_unstemmed Outcome and survival of asymptomatic PML in natalizumab-treated MS patients
title_short Outcome and survival of asymptomatic PML in natalizumab-treated MS patients
title_sort outcome and survival of asymptomatic pml in natalizumab-treated ms patients
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241803/
https://www.ncbi.nlm.nih.gov/pubmed/25493267
http://dx.doi.org/10.1002/acn3.114
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