Mild progressive multifocal leukoencephalopathy after switching from natalizumab to ocrelizumab

OBJECTIVE: To describe the disease course of carryover progressive multifocal leukoencephalopathy (PML) after switching from natalizumab to ocrelizumab in 2 patients with relapsing-remitting MS. METHODS: Two case reports with 1 year of follow-up and retrospective longitudinal measurements of serum n...

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Detalles Bibliográficos
Autores principales: Toorop, Alyssa A., van Lierop, Zoë Y.G., Strijbis, Eva E.M., Teunissen, Charlotte E., Petzold, Axel, Wattjes, Mike P., Barkhof, Frederik, de Jong, Brigit A., van Kempen, Zoé L.E., Killestein, Joep
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577542/
https://www.ncbi.nlm.nih.gov/pubmed/33051344
http://dx.doi.org/10.1212/NXI.0000000000000904
Descripción
Sumario:OBJECTIVE: To describe the disease course of carryover progressive multifocal leukoencephalopathy (PML) after switching from natalizumab to ocrelizumab in 2 patients with relapsing-remitting MS. METHODS: Two case reports with 1 year of follow-up and retrospective longitudinal measurements of serum neurofilament light (NfL) levels and B-cells. RESULTS: PML was diagnosed 78 days (case 1) and 97 days (case 2) after discontinuation of natalizumab. Both patients developed mild immune reconstitution inflammatory syndrome (IRIS) despite B-cell depletion caused by ocrelizumab. NfL levels increased in both patients during PML-IRIS. PML-IRIS lesions stabilized after treatment with mefloquine and mirtazapine, followed by methylprednisolone, and both patients continued therapy with ocrelizumab when B-cells started to repopulate. CONCLUSIONS: The clinical course of carryover PML was mild in both patients, suggesting that B-cell depletion possibly did not aggravate PML-IRIS in these 2 patients.

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