2012/01/18 by David Hunt, Gavin Giovannoni · 1 citation
Engineering · Medicine · #Antenna Design and Analysis #Disease #Dosing #Full-Duplex Wireless Communications #Immunology #Intensive care medicine #Internal medicine #JC virus #Medicine #Multiple sclerosis #Natalizumab #Oncology #Polyomavirus and related diseases #Progressive multifocal leukoencephalopathy #Risk stratification
paper · doi:10.1136/practneurol-2011-000092
openalex publication_date 2012/01/18 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/19
Natalizumab reduces relapse frequency, delays onset of disease progression and improves disease outcomes in relapsing-remitting multiple sclerosis (MS) and is a cost-effective treatment for rapidly evolving severe relapsing-remitting MS. However, it is associated with the development of progressive multifocal leucoencephalopathy (PML), a serious opportunistic brain infection caused by a neurotropic strain of the JC virus (JCV). Until May 2011, 83 300 patients had received natalizumab for MS. One hundred and twenty-four patients had developed PML, of whom 23 (19%) died. In order to maximise the benefit-risk ratio of natalizumab for MS patients it is important to develop a strategy for risk profiling and monitoring for PML. Central to this is an understanding of the biology of the JCV and the emerging clinical picture of natalizumab-associated PML. This paper reviews the evidence for managing the risk of PML in natalizumab-treated patients and the authors propose an algorithm for risk profiling and risk management. Key features of this algorithm include risk stratification based on emerging risk factors, heightened clinical vigilance for the clinical features of natalizumab-associated PML and considerations for temporary and permanent cessation of natalizumab dosing.