Natalizumab-PML survivors with subsequent MS treatment

Elisabeth Maillart (1) , Jean-Sebastien Vidal (2) , David Brassat (3) , Bruno Stankoff (4) , Agnès Fromont (4) , Jérôme de Sèze (5) , Frédéric Taithe (6) , Pierre Clavelou (6) , Bertrand Bourre (7) , Valérie Delvaux (8) , Audrey Rico (9, 10, 11) , Pierre Labauge (12) , Ayman Tourbah (13) , Christine Lebrun (14) , Jean Pelletier (9, 10, 11) , Thibault Moreau (4) , Céline Louapre (1) , Catherine Lubetzki (1) , Caroline Papeix (1)

1 CHU Pitié-Salpêtrière [AP-HP]
2 Department of Gerontology, Broca Hospital, APHP, Paris
3 Département Neurologie [CHU Toulouse]
4 CHU Saint-Antoine [AP-HP]
5 Service de Neurologie générale, vasculaire et dégénérative (CHU de Dijon)
6 Department of Neurology, University Hospital of Clermont-Ferrand
7 Department of neurology, university hospital of Rouen
8 Department of Neurology, University Hospital of Liège, Belgium
9 Neurologie, maladies neuro-musculaires [Hôpital de la Timone - APHM]
10 CRMBM - Centre de résonance magnétique biologique et médicale
11 CEMEREM - Centre d'Exploration Métabolique par Résonance Magnétique [Hôpital de la Timone - APHM]
12 Department of Neurology, University Hospital of Montpellier
13 Hôpital universitaire Robert Debré [Reims]
14 Department of Neurology, University Hospital of Nice

Objective: To describe the clinico-radiologic outcome of MS patients with natalizumab-related progressive multifocal leukoencephalopathy (Nz-PML) surviving and receiving disease-modifying therapy (DMT). Methods: We describe clinical and radiologic evolution of Nz-PML survivors in an observational retrospective multicenter cohort to clarify the effect of different subsequent MS DMT strategies. Twenty-three patients from 11 centers were analyzed. Outcomes were (1) clinical efficacy of post-PML MS DMT, (2) radiologic efficacy of post-PML MS DMT, (3) radiologic evolution of PML lesion, and (4) disability progression. Results: There was no clinical worsening of PML symptoms with a stability of Expanded Disability Status Scale at the last follow-up. No relapse was reported with fingolimod and dimethyl fumarate. No radiologic worsening of Nz-PML lesion was observed at the end of the follow-up. Conclusion: In this large cohort of patients with Nz-PML, MS therapies given after Nz discontinuation were not associated with PML worsening. A larger cohort with longer follow-up will be necessary to confirm this therapeutic strategy.

Domaines: Immunothérapie

Elisabeth Maillart, Jean-Sebastien Vidal, David Brassat, Bruno Stankoff, Agnès Fromont, et al.. Natalizumab-PML survivors with subsequent MS treatment. Neurology Neuroimmunology & Neuroinflammation, 2017, 4 (3), pp.e346. ⟨10.1212/NXI.0000000000000346⟩. ⟨hal-03539165⟩