Can natalizumab cause PML?

Natalizumab treatment is associated with the risk of progressive multifocal leukoencephalopathy (PML), an opportunistic brain infection that is caused by the JC virus.

What is PML natalizumab?

TYSABRI® (natalizumab) increases the risk of PML, an opportunistic viral infection of the brain that usually leads to death or severe disability. Risk factors for the development of PML include the presence of anti-JCV antibodies, duration of therapy, and prior use of immunosuppressants.

How do you test for PML?

Your healthcare provider can diagnose PML with tests that evaluate your brain and spinal cord. You may have: MRI to take images of the brain. Spinal tap to sample and evaluate your cerebrospinal fluid (fluid that surrounds tissue in your brain and spinal cord).

Why does Tysabri cause PML?

How are Tysabri and PML linked? We need our white blood cells to fight off infections. Tysabri can suppress the immune system and blocks white blood cells from getting into the brain. That means if we get an infection (like PML) that attacks the brain, our immune system can’t fight it.

What is the difference between Tysabri and Ocrevus?

Ocrevus and Tysabri are different types of monoclonal antibodies. Ocrevus is a CD20-directed cytolytic antibody and Tysabri is a recombinant humanized IgG4? monoclonal antibody. Side effects of Ocrevus and Tysabri that are similar include depression.

Can Covid cause PML?

Another mechanism could be the lymphopenia that occurs sometimes during COVID-19 (Song et al. 2020). Such lymphopenia may have suppressed JCV T-cell response and thus give account of PML progression.

What are the guidelines for the management of suspected PML?

If PML is suspected, clinicians should hold DMT pending further evaluation, depending on the level of suspicion. A clinician may repeat a brain MRI in 1 month if a new subcortical lesion develops, but further immediate evaluation with lumbar puncture for JCV PCR is reasonable depending upon the patient’s JCV antibody status and clinical history.

Are Kaplan–Meier curves regionally stratified for natalizumab‐treated patients with positive JCV?

However, Ho et al.’s publication is actually sufficiently detailed to derive regionally stratified Kaplan–Meier curves, for natalizumab‐treated patients with a positive JCV serostatus but no prior IS exposure having received up to 72 infusions (Fig. 1).

What are the risk factors for progressive multifocal leukoencephalopathy in natalizumab-treated patients?

At present, three risk factors for the development of progressive multifocal leukoencephalopathy (PML) in natalizumab-treated patients have been identified: the presence of antibodies against JC virus (JCV); the duration of natalizumab treatment, especially if longer than 2 years; and the use of immunosuppressants prior to receiving natalizumab.