MS Speaks

Mult Scler. 2016 Sep 6.
Predictors of severity and functional outcome in natalizumab-associated progressive multifocal leukoencephalopathy

Hoepner R1, Kolb EM2, Dahlhaus S3, Hellwig K2, Adams O4, Kleiter I2, Salmen A5, Schneider R2, Lukas C6, Chan A5, Berger JR7, Gold R2.

Author information

1Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany roberthoepner@gmx.de.
2Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
3Department of Neurology, Alfried Krupp Hospital, Essen, Germany.
4Department of Virology, Heinrich Heine University, Düsseldorf, Germany.
5Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany/Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.
6Department of Radiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
7Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.

OBJECTIVE:

Progressive multifocal leukoencephalopathy (PML) is an emerging complication of immunosuppressive therapies, especially natalizumab in multiple sclerosis (MS). Factors associated with functional outcome of natalizumab-associated PML (natalizumab-PML) have not been sufficiently described.

METHODS:

We retrospectively analyzed medical records of all patients with natalizumab-PML (n = 32) treated in our hospital since 2009. Disability measured by Expanded Disability Status Scale (EDSS) at two different time points (highest available EDSS during PML and last available EDSS after PML diagnosis) served as functional outcome parameters. Clinical, laboratory, and imaging data were analyzed for association with functional outcome by applying Spearman's rho and multivariate regression analysis.

RESULTS:

In all, 31/32 patients survived PML. A poor functional outcome was associated with higher age, higher initial John Cunningham virus (JCV) copy number in cerebrospinal fluid (CSF), and more extensive PML lesions on initial magnetic resonance imaging (MRI). No association between functional outcome and the duration of natalizumab therapy or a delayed PML diagnosis was observed.

CONCLUSION:

This study will be useful for neurological practice to estimate functional outcome or disease severity of natalizumab-PML in primary care settings.