If caught early, Natalizumab-PML not fatal for multiple sclerosis patients

From St. Josef Hospital at Ruhr University in Bochum, Germany

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An article published in the Archives of Neurology reports, "In the setting of early diagnosis and consequent treatment, natalizumab-associated PML can be well managed in some cases."

Alexandra Schroder, M.D., the lead investigator from Ruhr-University in Bochum, Germany points out that this is different for those who don't have multiple sclerosis (MS) and get PML.

PML, progressive multifocal leukoencephalopathy, is a rare, always serious and often fatal disease that damages the white matter of the brain at multiple locations.  It is caused by the activation of the JC virus (which is normally present but kept under control by the immune system) by immmunosupressive drugs such as natalizumab (Tysabri).

The newest research is showing that, caught early, PML doesn't have to be as much of a worry as it has been.  "We used to think PML was always fatal, but now we are learning that it might not always be," says Kate Weiss, a spokesperson for Biogen, Inc., the makers of natalizumab.

Dr. Cohen from the Cleveland Clinic Mellen Center for Multiple Sclerosis was asked by Medscape his thoughts, "PML continues to be the main concern with natalizumab." But he adds that with early detection and treatment, the benefits may still outweigh the risks for carefully selected patients."

The paper Medscape reported on shows investigators treating a 41-year old woman with relapsing-remitting MS who developed PML after she was given 29 infusions of Tysabri.

The JC virus wasn't seen in her cerebrospinal fluid, plasma or urine after three months and investigators were able to quit giving her the mefloquine and mirtazapine.  She then received therapy with glatiramer acetate (Copaxone) and showed a "steady Expanded Disability Status Scale score of 3.5 compared with before PML."

The investigators are talking of additional studies and regulators will continue to monitor for new cases of PML.  "We recommend stringent monitoring as outlined by the Tysabri Outreach Unified Commitment to Health (TOUCH) program in the US," Weiss said.

Pamela Vaughn of Lima, who has been diagnosed with MS for 10 years, hasn't wanted to do Tysabri because of PML problems.  "PML is something that scared me a lot since I already have the problems I do have with my MS, and even with this new finding, I find that I am just fine with my Rebif shots.  I have no interest in changing that."

She continues, "I have a friend who is doing it and he has been fine, but for me, the choice has been and always wil be 'why add the possibility of more and maybe worse' than what I already have."