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Traboulsee A, Li DKB. Routine MR Imaging Protocol and Standardization in Central Nervous System Demyelinating Diseases. Neuroimaging Clin N Am 2024; 34:317-334. [PMID: 38942519 DOI: 10.1016/j.nic.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Standardized MR imaging protocols are important for the diagnosis and monitoring of patients with multiple sclerosis (MS) and the appropriate use of MR imaging in routine clinical practice. Advances in using MR imaging to establish an earlier diagnosis of MS, safety concerns regarding intravenous gadolinium-based contrast agents, and the value of spinal cord MR imaging for diagnostic, prognostic, and monitoring purposes suggest a changing role of MR imaging for the management and care of MS patients. The MR imaging protocol emphasizes 3 dimensional acquisitions for optimal comparison over time.
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Affiliation(s)
- Anthony Traboulsee
- Department of Medicine (Neurology), University of British Columbia, University of British Columbia Hospital, 2211 Wesbrook Mall, Room S113, Vancouver, British Columbia V6T 2B5, Canada.
| | - David K B Li
- Department of Radiology, University of British Columbia, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada
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2
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Skarlis C, Papadopoulos V, Raftopoulou S, Mavragani CP, Evangelopoulos ME. Association of B-cell activating factor gene variants with serum anti-JCV antibody positivity in male patients with multiple sclerosis under natalizumab treatment: Implications for progressive multifocal leukoencephalopathy risk stratification. J Neurol Sci 2024; 461:123046. [PMID: 38761670 DOI: 10.1016/j.jns.2024.123046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Progressive multifocal leukoencephalopathy (PML) is a potentially life-threatening complication among Multiple Sclerosis (MS) patients under natalizumab treatment, with serum anti-JCV antibody titers being used for stratification risk. Given the critical role of interferon (IFN)/B-cell activating factor (BAFF) axis in humoral immune responses against viruses, we explored whether it is involved in the generation of serum anti-JCV antibodies among these patients. METHODS 162 consecutive patients with relapsing-remitting MS under natalizumab treatment were included. Serum anti-JCV antibodies were measured at baseline, as well as 12 and 24 months after treatment initiation. Type I and II IFN-inducible genes and BAFF expression were quantitated in peripheral blood by qRT-PCR. Moreover, BAFF rs9514828, rs1041569, and rs9514827 gene variants were assessed by RFLP-PCR. RESULTS While type I and II IFN inducible gene expression were not associated with anti-JCV serum titers, the latter were significantly correlated with BAFF gene expression. Of interest, the TTT haplotype of the studied BAFF variants was more frequently detected in male, but not female anti-JCV (+) MS patients compared to anti-JCV (-) counterparts at baseline, as well as at 12 months and 24 months of natalizumab treatment. Measures of clinical validity/utility for the BAFF TTT haplotype showed 88% specificity, 45%, positive predictive value, and sensitivity of 70% for the discrimination of anti-JCV (+) male MS patients after 24 months of treatment. CONCLUSIONS Our study suggests an implication of the BAFF axis in the production of serum anti-JCV antibodies. Additionally, the BAFF TTT haplotype derived from the rs9514828, rs1041569, and rs9514827 variants may represent a novel risk factor for anti-JCV seropositivity and indirectly for PML development among male MS patients treated with natalizumab.
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Affiliation(s)
- Charalampos Skarlis
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, M. Asias 75, 11527 Athens, Greece
| | - Vassilis Papadopoulos
- First Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sylvia Raftopoulou
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, M. Asias 75, 11527 Athens, Greece
| | - Clio P Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, M. Asias 75, 11527 Athens, Greece; Joint Academic Rheumatology Program, NKUA, Greece.
| | - Maria-Eleftheria Evangelopoulos
- First Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Moser T, Zimmermann G, Baumgartner A, Berger T, Bsteh G, Di Pauli F, Enzinger C, Fertl E, Heller T, Koppi S, Rommer PS, Safoschnik G, Seifert-Held T, Stepansky R, Sellner J. Long-term outcome of natalizumab-associated progressive multifocal leukoencephalopathy in Austria: a nationwide retrospective study. J Neurol 2024; 271:374-385. [PMID: 37728757 PMCID: PMC10770206 DOI: 10.1007/s00415-023-11924-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/28/2023] [Accepted: 08/06/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND/OBJECTIVE The use of natalizumab (NAT) in multiple sclerosis (MS) may be complicated by progressive multifocal leukoencephalopathy (PML), a rare and life-threatening opportunistic brain infection. We aimed to analyze the course of MS after PML recovery together with the long-term outcome of NAT-associated PML (NAT-PML) in Austria. METHODS Retrospective study based on identification of cases in the nationwide Austrian MS treatment registry (AMSTR) and MS centers with review of patient records. The expanded disability status scale (EDSS) was used to measure neurological disability and outcome. RESULTS As of December 2022, we identified 15 NAT-PML cases in Austria; only 20% occurred after 2016, when increased vigilance commenced. Two patients did not survive acute PML, and an additional patient died five years later, yielding a mortality rate of 20%. Seizures occurred exclusively in patients with pronounced EDSS increase. Gadolinium (Gd)-enhancement on brain magnetic resonance imaging (MRI) on PML suspicion was associated with minor changes of post-PML neurological disability. Long-term follow-up of up to 132 months (median 76 months) was available in 11/15. The overall median EDSS increased from 3.5 at pre-PML to 6.5 at the last assessment. Regarding inflammatory MS-related disease activity during the observation period, one single individual experienced an MS relapse and another patient had two Gd-enhancing brain lesions. Three patients converted to progressive MS within three years from PML and the EDSS further increased in 6/11. CONCLUSIONS The number of NAT-PML cases is decreasing over time. While many patients accumulated severe persistent neurological deficits compared to pre-PML, inflammatory MS-related disease activity after PML recovery was rare.
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Affiliation(s)
- Tobias Moser
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Georg Zimmermann
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Anna Baumgartner
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elisabeth Fertl
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Thomas Heller
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Stefan Koppi
- Rehabilitation Clinic Montafon, Schruns, Austria
| | - Paulus S Rommer
- Department of Neurology, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Johann Sellner
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstrasse 67, 2130, Mistelbach, Austria.
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Khatri BO, Olapo T, Beals S, Lindman E, Perea T, Van Zealand P, Metzger RR. Lessons learned after 20 years of real-world experience with natalizumab. Mult Scler Relat Disord 2023; 80:105048. [PMID: 37866023 DOI: 10.1016/j.msard.2023.105048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/04/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND While natalizumab (NTZ) is an effective therapy for multiple sclerosis (MS), it is associated with an increased risk of progressive multifocal leukoencephalopathy (PML). After 20 years (2002-2022) of experience with NTZ at our center, we observed no cases of PML. OBJECTIVES We evaluated the likelihood of experiencing PML in a subset of our treatment cohort, as well as reviewed treatment practices at our center that may mitigate PML risk. METHODS For this retrospective study, we reviewed patient characteristics, treatment practices, and clinical and MRI findings in patients receiving NTZ from 2006 to 2020. Observation of no PML cases was compared to the global and US PML incidences, and to the expected incidence based on published risk estimates. RESULTS 766 patients were evaluated. The number of NTZ infusions received ranged from 1 to 126, with a mean of 28. Patients received neurological examination prior to each infusion, which sometimes resulted in a pause in therapy to rule out PML if clinical worsening occurred. Extended interval dosing (EID) was the overall dosing schedule for 31% of patients. EID did not result in higher rates of radiological disease worsening than standard interval dosing (SID) patients. Depending on the analysis conducted, the finding of 0 PML cases in our cohort ranged from slightly unexpected to slightly expected. CONCLUSIONS The utilization of EID as well as regular clinical monitoring of patients may have lowered PML risk while still maintaining NTZ efficacy.
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Affiliation(s)
- Bhupendra O Khatri
- The Regional MS Center, Center for Neurological Disorders SC, Ascension St. Francis Hospital, 3237 S. 16th Street, Milwaukee, WI 53215, United States.
| | - Tayo Olapo
- The Regional MS Center, Center for Neurological Disorders SC, Ascension St. Francis Hospital, 3237 S. 16th Street, Milwaukee, WI 53215, United States
| | - Sara Beals
- The Regional MS Center, Center for Neurological Disorders SC, Ascension St. Francis Hospital, 3237 S. 16th Street, Milwaukee, WI 53215, United States
| | - Emily Lindman
- The Regional MS Center, Center for Neurological Disorders SC, Ascension St. Francis Hospital, 3237 S. 16th Street, Milwaukee, WI 53215, United States
| | - Toni Perea
- The Regional MS Center, Center for Neurological Disorders SC, Ascension St. Francis Hospital, 3237 S. 16th Street, Milwaukee, WI 53215, United States
| | - Pamela Van Zealand
- The Regional MS Center, Center for Neurological Disorders SC, Ascension St. Francis Hospital, 3237 S. 16th Street, Milwaukee, WI 53215, United States
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Lafontaine JC, Boucher J, Giovannelli J, Petit J, Outteryck O, Balagny S, Zéphir H. Evaluation of risk management in a natalizumab home infusion procedure. Rev Neurol (Paris) 2023; 179:894-901. [PMID: 37202259 PMCID: PMC10186396 DOI: 10.1016/j.neurol.2023.01.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/21/2023] [Accepted: 01/26/2023] [Indexed: 05/20/2023]
Abstract
Natalizumab is a well-established disease-modifying therapy used in active multiple sclerosis (MS). The most serious adverse event is progressive multifocal leukoencephalopathy. For safety reasons, hospital implementation is mandatory. The SARS-CoV-2 pandemic has deeply affected hospital practices leading French authorities to temporarily authorize to administer the treatment at home. The safety of natalizumab home administration should be assessed to allow ongoing home infusion. The aim of the study is to describe the procedure and assess the safety in a home infusion natalizumab model. Patients presenting relapsing-remitting MS treated by natalizumab for over two years, non-exposed to John Cunningham Virus (JCV) and living in the Lille area (France) were included from July 2020 to February 2021 to receive natalizumab infusion at home every four weeks for 12 months. Teleconsultation occurrence, infusion occurrence, infusion cancelling, JCV risk management, annual MRI completion were analyzed. The number of teleconsultations allowing infusion was 365 (37 patients included in the analysis), all home infusions were preceded by a teleconsultation. Nine patients did not complete the one-year home infusion follow-up. Two teleconsultations canceled infusions. Two teleconsultations led to a hospital visit to assess a potential relapse. No severe adverse event was reported. All 28 patients who have completed the follow-up benefited from biannual hospital examination and JCV serologies and annual MRI. Our results suggested that the established home natalizumab procedure was safe using the university hospital home-care department. However, the procedure should be evaluated using home-based services outside the university hospital.
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Affiliation(s)
- J-C Lafontaine
- Université de Lille, Lille, France; Department of neurology, CHU de Lille, Lille, France
| | - J Boucher
- Department of neurology, CHU de Lille, Lille, France
| | - J Giovannelli
- GIOVANNELLI Epidemiology and clinical research counselling, Lille, France
| | - J Petit
- Department of neurology, CHU de Lille, Lille, France
| | - O Outteryck
- Department of neuroradiology, CHU de Lille, Inserm U1171 Lille, Lille, France
| | - S Balagny
- Home care department CHU de Lille, Lille, France
| | - H Zéphir
- Université de Lille, Lille, France; Department of neurology, CHU de Lille, Lille, France; Inserm U1172, Lille, France.
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Hartung HP, Mares J, Meuth SG, Berger T. Multiple Sclerosis: Switching from Natalizumab to Other High-Efficacy Treatments to Mitigate Progressive Multifocal Leukoencephalopathy Risk. Neurotherapeutics 2021; 18:1654-1656. [PMID: 34480292 PMCID: PMC8609079 DOI: 10.1007/s13311-021-01102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Hans-Peter Hartung
- Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- Brain and Mind Centre, University of Sydney, Sydney, Australia.
- Department of Neurology, Palacky University, Olomouc, Olomouc, Czech Republic.
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
| | - Jan Mares
- Department of Neurology, Palacky University, Olomouc, Olomouc, Czech Republic
| | - Sven G Meuth
- Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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