PMID- 26856928
OWN - NLM
STAT- MEDLINE
DCOM- 20161031
LR  - 20201229
IS  - 1879-114X (Electronic)
IS  - 0149-2918 (Linking)
VI  - 38
IP  - 3
DP  - 2016 Mar
TI  - Immune-reconstitution Inflammatory Syndrome in Multiple Sclerosis Patients 
      Treated With Natalizumab: A Series of 4 Cases.
PG  - 670-5
LID - S0149-2918(16)00023-0 [pii]
LID - 10.1016/j.clinthera.2016.01.010 [doi]
AB  - PURPOSE: Natalizumab (NTZ) is an effective treatment for relapsing-remitting 
      multiple sclerosis (RRMS). Progressive multifocal leukoencephalopathy (PML) is a 
      rare complication of NTZ treatment. In patients developing PML, NTZ cessation 
      causes a reconstruction of cellular immunity, a rapid transition of cells through 
      the blood-brain barrier, and significant inflammation in the central nervous 
      system, leading to immune-reconstitution inflammatory syndrome (IRIS), with 
      potentially poor outcomes. The occurrence of this syndrome is accelerated by 
      plasmapheresis, the standard treatment for NTZ-PML, due to enhanced clearance of 
      NTZ and thus rapid reconstitution of cellular immunity. IRIS can also occur after 
      cessation of NTZ in the absence of PML. METHODS: We describe 4 patients who 
      developed IRIS after NTZ cessation. FINDINGS: For the first patient, treatment 
      was switched to fingolimod to avoid risk of developing PML. Despite 
      plasmapheresis, corticosteroids, and other therapies, the outcome in this patient 
      was fatal. For the 3 other patients, PML was detected early on magnetic resonance 
      imaging, and IRIS after NTZ cessation was managed with a favorable outcome; 1 of 
      these patients was managed without plasmapheresis or corticosteroid treatment. 
      IMPLICATIONS: These cases demonstrate the need to consider and manage therapeutic 
      strategies relative to the individual patient's risk for PML or IRIS. NTZ 
      cessation to avoid PML risk can lead to severe IRIS without PML. On the other 
      hand, if PML develops and is detected early, plasmapheresis may not be considered 
      necessary and IRIS may be limited, with a favorable outcome. These 2 scenarios 
      should be considered when managing NTZ MS patients.
CI  - Copyright (c) 2016 Elsevier HS Journals, Inc. All rights reserved.
FAU - N'gbo N'gbo Ikazabo, Rosy
AU  - N'gbo N'gbo Ikazabo R
AD  - Neuroimmunology Unit, Neurology Service, Erasme Hospital, Universite Libre de 
      Bruxelles, Brussels, Belgium.
FAU - Mostosi, Christian
AU  - Mostosi C
AD  - Neuroimmunology Unit, Neurology Service, Erasme Hospital, Universite Libre de 
      Bruxelles, Brussels, Belgium.
FAU - Quivron, Benedicte
AU  - Quivron B
AD  - Centre Hospitalier de Jolimont-Lobbes, Lobbes, Belgium.
FAU - Delberghe, Xavier
AU  - Delberghe X
AD  - Centre Hospitalier de Wallonie picarde, Site Union, Tournai, Belgium.
FAU - El Hafsi, Kaoutar
AU  - El Hafsi K
AD  - Neuroimmunology Unit, Neurology Service, Erasme Hospital, Universite Libre de 
      Bruxelles, Brussels, Belgium.
FAU - Lysandropoulos, Andreas P
AU  - Lysandropoulos AP
AD  - Neuroimmunology Unit, Neurology Service, Erasme Hospital, Universite Libre de 
      Bruxelles, Brussels, Belgium. Electronic address: 
      andreas.lysandropoulos@erasme.ulb.ac.be.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160205
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Natalizumab)
SB  - IM
MH  - Adult
MH  - Antibodies, Monoclonal, Humanized/adverse effects/therapeutic use
MH  - Female
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*chemically induced
MH  - Leukoencephalopathy, Progressive Multifocal/*chemically induced
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Multiple Sclerosis/*drug therapy
MH  - Multiple Sclerosis, Relapsing-Remitting/drug therapy
MH  - Natalizumab/administration & dosage/*adverse effects
MH  - Young Adult
OTO - NOTNLM
OT  - JC virus
OT  - immune-reconstitution inflammatory syndrome
OT  - multiple sclerosis
OT  - natalizumab
OT  - progressive multifocal leukoencephalopathy
EDAT- 2016/02/10 06:00
MHDA- 2016/11/01 06:00
CRDT- 2016/02/10 06:00
PHST- 2015/09/15 00:00 [received]
PHST- 2015/12/14 00:00 [revised]
PHST- 2016/01/13 00:00 [accepted]
PHST- 2016/02/10 06:00 [entrez]
PHST- 2016/02/10 06:00 [pubmed]
PHST- 2016/11/01 06:00 [medline]
AID - S0149-2918(16)00023-0 [pii]
AID - 10.1016/j.clinthera.2016.01.010 [doi]
PST - ppublish
SO  - Clin Ther. 2016 Mar;38(3):670-5. doi: 10.1016/j.clinthera.2016.01.010. Epub 2016 
      Feb 5.