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Mitsikostas DD, Mastorodemos V, Tsagournizakis M, et al. Natalizumab-related progressive multifocal leukoencephalopathy in Greece. Mult Scler Relat Disord. 2013;3(2):203-10doi: 10.1016/j.msard.2013.08.006.
Mitsikostas, D. D., Mastorodemos, V., Tsagournizakis, M., Kodounis, A., Tsagkaropoulos, A., Konitsiotis, S., Toulas, P., Papadimitriou, A., Papadimitriou, D., Tavernarakis, A., & Papadopoulos, D. (2014). Natalizumab-related progressive multifocal leukoencephalopathy in Greece. Multiple sclerosis and related disorders, 3(2), 203-10. https://doi.org/10.1016/j.msard.2013.08.006
Mitsikostas, Dimos D, et al. "Natalizumab-related progressive multifocal leukoencephalopathy in Greece." Multiple sclerosis and related disorders vol. 3,2 (2014): 203-10. doi: https://doi.org/10.1016/j.msard.2013.08.006
Mitsikostas DD, Mastorodemos V, Tsagournizakis M, Kodounis A, Tsagkaropoulos A, Konitsiotis S, Toulas P, Papadimitriou A, Papadimitriou D, Tavernarakis A, Papadopoulos D. Natalizumab-related progressive multifocal leukoencephalopathy in Greece. Mult Scler Relat Disord. 2014 Mar;3(2):203-10. doi: 10.1016/j.msard.2013.08.006. Epub 2013 Sep 24. PMID: 25878008.
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Mult Scler Relat Disord. 2014 Mar;3(2):203-10. doi: 10.1016/j.msard.2013.08.006. Epub 2013 Sep 24.

Natalizumab-related progressive multifocal leukoencephalopathy in Greece.

Multiple sclerosis and related disorders

Dimos D Mitsikostas, Vasileios Mastorodemos, Minas Tsagournizakis, Antonios Kodounis, Antonios Tsagkaropoulos, Spyridon Konitsiotis, Panagiotis Toulas, Alexandros Papadimitriou, Dimitra Papadimitriou, Antonios Tavernarakis, Dimitrios Papadopoulos

Affiliations

  1. Neurology Department, Athens Naval Hospital, 40 Deinokratous Street, 77A Vasilissis Sofias Avenue, 11521 Athens, Greece. Electronic address: [email protected].
  2. Neurology Department, Heraklion University Hospital, Voutes, 71110 Heraklion, Crete, Greece.
  3. Neurology Department, 251 General Airforce Hospital, Kanellopoulou 3, 11525 Athens, Greece.
  4. Neurology Department, University of Ioannina Medical School, Ioannina, Greece.
  5. Radiology Department, Encephalos-EUROMEDICA, Rizariou 3, Halandri, 15233 Athens, Greece.
  6. Neurology Department, Henry Dunant Hospital, Mesogeion 107, 11526 Athens, Greece.
  7. Neurology Department, Evangelismos General Hospital, Ipsilantou 45-47, 10676 Athens, Greece.
  8. Neurology Department, Athens Naval Hospital, 40 Deinokratous Street, 77A Vasilissis Sofias Avenue, 11521 Athens, Greece; Neurology Department, Evangelismos General Hospital, Ipsilantou 45-47, 10676 Athens, Greece.

PMID: 25878008 DOI: 10.1016/j.msard.2013.08.006

Abstract

BACKGROUND & OBJECTIVES: Progressive multifocal leukoencephalopathy (PML) may complicate natalizumab treatment in multiple sclerosis patients. We sought to characterize the clinical and laboratory features of natalizumab-related PML (NR-PML) cases from Greece.

METHODS: Pharmaceutical industry, national drug authorities and all neurology departments within the Greek territory were asked to provide data for cases of NR-PML until October 2012. Collected cases were classified according to their level of diagnostic certainty using the five-level system introduced by Mentzer et al. (2012).

RESULTS: Thirteen NR-PML cases were identified by the neurology departments. Data were provided for only 9 cases. PML manifestations appeared after a median number of 40 (21-52) natalizumab infusions. All but two patients were treated with plasma exchange and some were treated adjunctively with mirtazapine while the others were treated with mefloquine. IRIS developed in 6 cases after a median time of 6 (2-10) weeks from PML presentation and were treated with different regimens of corticosteroids. PML was fatal in 3 cases. The median EDSS after a median follow-up time of 12 (8-23) months in the surviving cases was 4.75 (2-8.5).

CONCLUSIONS: Outcomes for collected NR-PML cases varied from death to returning to baseline. Close surveillance is essential for early diagnosis and treatment of NR-PML patients.

Copyright © 2013 Elsevier B.V. All rights reserved.

Keywords: Adverse events; Immune reconstitution inflammatory syndrome; Multiple sclerosis; Natalizumab; Progressive multifocal leukoencephalopathy; Treatment

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