Open AccessOutcome and survival of asymptomatic PML in natalizumab‐treated MS patients
Author(s) -
DongSi Tuan,
Richman Sandra,
Wattjes Mike P.,
Wenten Made,
Gheuens Sarah,
Philip Jeffrey,
Datta Shoibal,
McIninch James,
Bozic Carmen,
Bloomgren Gary,
Richert Nancy
Publication year - 2014
Publication title -
annals of clinical and translational neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.824
H-Index - 42
ISSN - 2328-9503
DOI - 10.1002/acn3.114
Subject(s) - medicine , asymptomatic , natalizumab , expanded disability status scale , multiple sclerosis , magnetic resonance imaging , progressive multifocal leukoencephalopathy , gastroenterology , surgery , radiology , immunology
Objective As of 3 September 2013, 399 cases of natalizumab‐associated progressive multifocal leukoencephalopathy ( PML ) were confirmed in multiple sclerosis ( MS ) patients. We evaluated outcomes of natalizumab‐treated MS patients who were asymptomatic at PML diagnosis. Methods Analyses included data available as of 5 June 2013. Asymptomatic patients diagnosed with PML by magnetic resonance imaging ( MRI ) findings and JC virus DNA detection in the central nervous system were compared with patients presenting with symptoms at diagnosis. Demographics, MRI , and survival over 12 months were analyzed. Expanded Disability Status Scale ( EDSS ) and Karnofsky Performance Scale ( KPS ) scores were recorded pre‐ PML , at diagnosis, and at 6 and 12 months post‐diagnosis. Results A total of 372 PML cases were analyzed; 30 patients were asymptomatic and 342 were symptomatic at PML diagnosis. Classifications of PML lesions on MRI in asymptomatic versus symptomatic patients were unilobar in 68% versus 37%, multilobar in 21% versus 24%, and widespread in 11% versus 40%. In both groups with unilobar lesions, frontal lobe lesions predominated. Prior to PML , mean EDSS and KPS scores were similar for asymptomatic and symptomatic patients. At diagnosis, mean EDSS score was significantly lower for asymptomatic patients (4.1; n = 11) than for symptomatic patients (5.4; n = 193; P = 0.038). Six months after PML diagnosis, asymptomatic patients had less functional disability than symptomatic patients. As of 5 June 2013, 96.7% of asymptomatic patients and 75.4% of symptomatic patients were alive. Interpretation PML patients asymptomatic at diagnosis had better survival and less functional disability than those who were symptomatic at diagnosis.