Abstract Details

Title Multiple sclerosis treatment strategy after natalizumab-associated progressive multifocal leukoencephalopathy

Topic Multiple Sclerosis

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-029

Objective To determine optimal management for MS after Nz-associated PML

Background Progressive multifocal leukoencephalopathy (PML) is a known serious complication associated with natalizumab (Nz) and JC virus seropositivity in patients treated for multiple sclerosis (MS) and Crohn’s disease. PML-related discontinuation of Nz requires re-establishing maintenance MS therapy, for which there is no recognized standard of care

Design/Methods We retrospectively analyzed clinical symptoms, diagnostic methods; survival outcome and MS therapy in 17 patients post Nz-PML at a tertiary care center from 2010–2017

Results Mean age of Nz-PML onset was 43.6 years and occurred on average after 44.5 infusions. 16 of 17 patients (94.1%) were alive and 1 suicide took place after 2 years of PML onset. 8 (47%) patients had at least 1 relapse 2 years post PML. 3 relapsed within the first year and 5 beyond 1 year post PML. Reactivation of MS after Nz discontinuation was lower than expected in this previously highly active cohort. 1 of 3 patients treated with maintenance monthly IV corticoids relapsed. Eight patients started other MS therapies post PML on average 26 months after Nz withdrawal, including 3 with dimethyl fumarate (DMF), 3 with glatiramer acetate (GA) and 2 with mycophenolate mofetil (MMF). One relapse occurred on MMF. No relapses were reported with GA and DMF. No recrudescence of PML occurred with these therapies

Conclusions Our findings suggest that treating MS post-Nz PML carries no risk of PML reactivation. PML may play a role in ameliorating the clinical course of MS. DMF and GA appears to be effective MS therapies after Nz-PML. Prospective studies, including larger number of patients are needed to confirm these findings

Authors/Disclosures
PRESENTER	No disclosure on file
Fabian Sierra Morales, MD	The institution of Dr. Sierra Morales has received research support from Rush Equity office .
Igor J. Koralnik, MD, FAAN (Northwestern University)	Dr. Koralnik has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Investigation. The institution of Dr. Koralnik has received research support from National Institutes of Health. Dr. Koralnik has received publishing royalties from a publication relating to health care.
Dusan Stefoski, MD, FAAN	No disclosure on file
Michael Ko, MD (CHPG Neuroscience and Spine - SAN Orchard)	No disclosure on file
Bichun Ouyang	Bichum Ouyang has nothing to disclose.
Lakshmi Warrior, MD, FAAN	Dr. Warrior has nothing to disclose.

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