6533b830fe1ef96bd1296833
RESEARCH PRODUCT
No evidence of beneficial effects of plasmapheresis in natalizumab-associated PML
Doriana LandiNicola De RossiSara ZagagliaCristina ScarpazzaLuca ProsperiniMaria AlbaneseFabio ButtariFrancesco MoriGirolama Alessandra MarfiaMaria Pia SormaniRuggero CapraDiego CentonzeMaria Pia The Italian Pml Study Group AmatoF BandiniAntonio BertolottoVincenzo Brescia-morraG CavalettiPaola CavallaMarco CapobiancoMarinella ClericoG D'aleoM De RizL DeottoLuca DurelliM FalciniE FerrariMl FuscoC GasperiniS GereviniA GhezziL GrimaldiM GuidottiA LugaresiP NaldiLucia MoiolaP PerroneM PizzornoC PozzilliM RezzonicoM RovarisG SalemiM SalvettiG SantuccioE ScarpiniE SessaC SolaroG TabiadonC TortorellaTrojano M.subject
OncologyMaleJC virus030204 cardiovascular system & hematologymedicine.disease_causeLeukoencephalopathyDisability Evaluationneurology (clinical); progressive multifocal leukoencephalopathy; reconstitution inflammatory syndrome; multiple-sclerosis0302 clinical medicineNatalizumabImmunologic FactorLeukoencephalopathyRetrospective StudieMultiple SclerosiMedicinePlasmapheresiAdult; Disability Evaluation; Female; Humans; Immunologic Factors; Leukoencephalopathy Progressive Multifocal; Male; Middle Aged; Multiple Sclerosis; Natalizumab; Plasmapheresis; PubMed; Retrospective Studies; Statistics Nonparametric; Treatment OutcomeProgressive multifocal leukoencephalopathyNatalizumabStatisticsLeukoencephalopathy Progressive MultifocalPlasmapheresisMiddle AgedTreatment OutcomeFemaleSettore MED/26 - Neurologiamedicine.drugHumanAdultmedicine.medical_specialtyPubMedMultiple SclerosisProgressive MultifocalStatistics Nonparametric03 medical and health sciencesImmune reconstitution inflammatory syndromeInternal medicineHumansImmunologic FactorsNonparametricprogressive multifocal leukoencephalopathy multiple sclerosis side effectRetrospective StudiesExpanded Disability Status Scalebusiness.industryMultiple sclerosisRetrospective cohort studymedicine.diseaseImmunologyNeurology (clinical)business030217 neurology & neurosurgerydescription
Objective:To examine retrospectively the effects of plasmapheresis (PLEX) on the survival and clinical outcomes of patients with multiple sclerosis (MS) and natalizumab (NTZ)–associated progressive multifocal leukoencephalopathy (PML).Methods:The medical literature was searched for the terms natalizumab and progressive multifocal leukoencephalopathy. A total of 193 international and 34 Italian NTZ-PML cases were included. Clinical outcome was determined by comparing the patients' clinical status at PML diagnosis with status after PML resolution. The effects on survival and clinical outcome of PLEX, sex, age, country, pre-PML Expanded Disability Status Scale score, NTZ infusion number, prior immunosuppressant exposure, PML symptoms, PML lesion location at diagnosis, CSF JC virus status and copies, additional PML treatments and steroids, and PML immune reconstitution inflammatory syndrome (IRIS) development were investigated with both univariate and multivariate analyses.Results:A total of 219 NTZ-PML cases were analyzed, and 184 (84%) underwent PLEX, which did not reduce the mortality risk or the likelihood of poor vs favorable outcomes. Country was predictive of mortality and poor outcome, while PML-IRIS development was predictive of poor outcome.Conclusions:PLEX did not improve the survival or clinical outcomes of Italian or international patients with MS and NTZ-PML, suggesting that this treatment should be performed cautiously in the future.Classification of evidence:This study provides Class III evidence that for patients with NTZ-PML, PLEX does not improve survival. The study lacks the statistical precision to exclude an important benefit or harm of PLEX.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2017-01-01 |