PMID- 28228569
OWN - NLM
STAT- MEDLINE
DCOM- 20170522
LR  - 20220408
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Linking)
VI  - 88
IP  - 12
DP  - 2017 Mar 21
TI  - No evidence of beneficial effects of plasmapheresis in natalizumab-associated 
      PML.
PG  - 1144-1152
LID - 10.1212/WNL.0000000000003740 [doi]
AB  - OBJECTIVE: To examine retrospectively the effects of plasmapheresis (PLEX) on the 
      survival and clinical outcomes of patients with multiple sclerosis (MS) and 
      natalizumab (NTZ)-associated progressive multifocal leukoencephalopathy (PML). 
      METHODS: The medical literature was searched for the terms natalizumab and 
      progressive multifocal leukoencephalopathy. A total of 193 international and 34 
      Italian NTZ-PML cases were included. Clinical outcome was determined by comparing 
      the patients' clinical status at PML diagnosis with status after PML resolution. 
      The effects on survival and clinical outcome of PLEX, sex, age, country, pre-PML 
      Expanded Disability Status Scale score, NTZ infusion number, prior 
      immunosuppressant exposure, PML symptoms, PML lesion location at diagnosis, CSF 
      JC virus status and copies, additional PML treatments and steroids, and PML 
      immune reconstitution inflammatory syndrome (IRIS) development were investigated 
      with both univariate and multivariate analyses. RESULTS: A total of 219 NTZ-PML 
      cases were analyzed, and 184 (84%) underwent PLEX, which did not reduce the 
      mortality risk or the likelihood of poor vs favorable outcomes. Country was 
      predictive of mortality and poor outcome, while PML-IRIS development was 
      predictive of poor outcome. CONCLUSIONS: PLEX did not improve the survival or 
      clinical outcomes of Italian or international patients with MS and NTZ-PML, 
      suggesting that this treatment should be performed cautiously in the future. 
      CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for 
      patients with NTZ-PML, PLEX does not improve survival. The study lacks the 
      statistical precision to exclude an important benefit or harm of PLEX.
CI  - (c) 2017 American Academy of Neurology.
FAU - Landi, Doriana
AU  - Landi D
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
FAU - De Rossi, Nicola
AU  - De Rossi N
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
FAU - Zagaglia, Sara
AU  - Zagaglia S
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
FAU - Scarpazza, Cristina
AU  - Scarpazza C
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
FAU - Prosperini, Luca
AU  - Prosperini L
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
FAU - Albanese, Maria
AU  - Albanese M
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
FAU - Buttari, Fabio
AU  - Buttari F
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
FAU - Mori, Francesco
AU  - Mori F
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
FAU - Marfia, Girolama Alessandra
AU  - Marfia GA
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
FAU - Sormani, Maria Pia
AU  - Sormani MP
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
FAU - Capra, Ruggero
AU  - Capra R
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy. ruggero.capra@gmail.com.
FAU - Centonze, Diego
AU  - Centonze D
AD  - From the Multiple Sclerosis Clinical and Research Unit, Department of Systems 
      Medicine (D.L., M.A., F.B., F.M., G.A.M., D.C.), Tor Vergata University, Rome; 
      IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (D.L., M.A., F.B., F.M., 
      G.A.M., D.C.), Pozzilli; Regional Multiple Sclerosis Center (N.D.R., C.S., R.C.), 
      ASST-Spedali Civili di Brescia, Montichiari; Neurological Clinic (S.Z.), Marche 
      Polytechnic University, Ancona; Department of Neurology and Psychiatry (L.P.), 
      Sapienza University, Rome; and Biostatistics Unit, Department of Health Sciences 
      (DISSAL) (M.P.S.), University of Genoa, Italy.
CN  - Italian PML study group
LA  - eng
PT  - Journal Article
DEP - 20170222
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
RN  - 0 (Immunologic Factors)
RN  - 0 (Natalizumab)
SB  - IM
MH  - Adult
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - Immunologic Factors/*therapeutic use
MH  - Leukoencephalopathy, Progressive Multifocal/mortality/*therapy
MH  - Male
MH  - Middle Aged
MH  - Multiple Sclerosis/therapy
MH  - Natalizumab/*therapeutic use
MH  - Plasmapheresis/*methods
MH  - PubMed/statistics & numerical data
MH  - Retrospective Studies
MH  - Statistics, Nonparametric
MH  - *Treatment Outcome
FIR - Amato, Maria Pia
IR  - Amato MP
FIR - Bandini, Fabio
IR  - Bandini F
FIR - Bertolotto, Antonio
IR  - Bertolotto A
FIR - Brescia-Morra, Vincenzo
IR  - Brescia-Morra V
FIR - Cavaletti, Guido
IR  - Cavaletti G
FIR - Cavalla, Paola
IR  - Cavalla P
FIR - Capobianco, Marco
IR  - Capobianco M
FIR - Clerico, Marinella
IR  - Clerico M
FIR - D'Aleo, Giangaetano
IR  - D'Aleo G
FIR - De Riz, Milena
IR  - De Riz M
FIR - Deotto, Luciano
IR  - Deotto L
FIR - Durelli, Luca
IR  - Durelli L
FIR - Falcini, Mario
IR  - Falcini M
FIR - Ferrari, Ernesta
IR  - Ferrari E
FIR - Fusco, Maria Letizia
IR  - Fusco ML
FIR - Gasperini, Claudio
IR  - Gasperini C
FIR - Gerevini, Simonetta
IR  - Gerevini S
FIR - Ghezzi, Angelo
IR  - Ghezzi A
FIR - Grimaldi, Luigi
IR  - Grimaldi L
FIR - Guidotti, Mario
IR  - Guidotti M
FIR - Lugaresi, Alessandra
IR  - Lugaresi A
FIR - Naldi, Paola
IR  - Naldi P
FIR - Moiola, Lucia
IR  - Moiola L
FIR - Perrone, Patrizia
IR  - Perrone P
FIR - Pizzorno, Matteo
IR  - Pizzorno M
FIR - Pozzilli, Carlo
IR  - Pozzilli C
FIR - Rezzonico, Monica
IR  - Rezzonico M
FIR - Rovaris, Marco
IR  - Rovaris M
FIR - Salemi, Giuseppe
IR  - Salemi G
FIR - Salvetti, Marco
IR  - Salvetti M
FIR - Santuccio, Giuseppe
IR  - Santuccio G
FIR - Scarpini, Elio
IR  - Scarpini E
FIR - Sessa, Edoardo
IR  - Sessa E
FIR - Solaro, Claudio
IR  - Solaro C
FIR - Tabiadon, Giulia
IR  - Tabiadon G
FIR - Tortorella, Carla
IR  - Tortorella C
FIR - Trojano, Maria
IR  - Trojano M
EDAT- 2017/02/24 06:00
MHDA- 2017/05/23 06:00
CRDT- 2017/02/24 06:00
PHST- 2016/07/20 00:00 [received]
PHST- 2016/10/23 00:00 [accepted]
PHST- 2017/02/24 06:00 [pubmed]
PHST- 2017/05/23 06:00 [medline]
PHST- 2017/02/24 06:00 [entrez]
AID - WNL.0000000000003740 [pii]
AID - 10.1212/WNL.0000000000003740 [doi]
PST - ppublish
SO  - Neurology. 2017 Mar 21;88(12):1144-1152. doi: 10.1212/WNL.0000000000003740. Epub 
      2017 Feb 22.