Fatal PML case in 78-year-old patient on Ocrevus monotherapy

From JAMA Neurology (March 16, 2021), "Progressive multifocal leukoencephalopathy in a patient with progressive multiple sclerosis treated with ocrelizumab monotherapy":


http://bit.ly/3eQm9ii

From MedPage Today (March 17, 2021)--"PML reported in ocrelizumab-treated MS patient":

This is the third article I've found on this topic, and so far there is no indication of how long the patient had had MS. It might be helpful to know that.

Medscape (March 29, 2021)--"First case of PML associated with ocrelizumab monotherapy":

The first article mentioned in this thread contains this information about the patient.

The patient had been diagnosed with MS almost 3 decades prior after developing gradual gait dysfunction and bilateral asymmetric leg weakness throughout several years. Despite continued slow gait worsening over years, he had not been treated with immunotherapy until ocrelizumab was approved by the US Food and Drug Administration for primary progressive MS in 2017. He began taking ocrelizumab at age 76 years soon after Food and Drug Administration approval. The patient’s JCV index was 2.48 prior to initiation, and the theoretical risk of PML was discussed prior to starting. He tolerated the treatments well but continued to exhibit worsening gait dysfunction.

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[/size]One wonders why a patient of 76 who has had PPMS for some 30 years would have been prescribed ocrelizumab.[/color]