RT Journal Article
SR Electronic
T1 DOES JCV ANTIBODY POSITIVITY ENCOURAGE CESSATION OF NATALIZUMAB THERAPY IN MULTIPLE SCLEROSIS?
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP e2
OP e2
DO 10.1136/jnnp-2013-306573.181
VO 84
IS 11
A1 Roisin Lonergan
A1 Katie Kinsella
A1 Siobhan Kelly
A1 Marguerite Duggan
A1 Jacqueline Scott
A1 Killian O'Rourke
A1 Timothy Lynch
A1 Michael Hutchinson
A1 Niall Tubridy
A1 Christopher McGuigan
YR 2013
UL http://jnnp.bmj.com/content/84/11/e2.92.abstract
AB Background Natalizumab, a monoclonal α–4–integren receptor antibody, is an effective immunomodulator in highly active relapsing remitting Multiple Sclerosis (HARRMS). Natalizumab has been associated with PML (progressive multifocal leucoencephaopathy), due to opportunistic reactivation of JC polyomavirus (JCv). PML risk may influence decisions to continue therapy. Risk relates to 3 identified risk factors: serum anti–JCv antibodies, prior immunosuppression and prolonged natalizumab therapy (>2 years). Recent commercial availability of a serum JCv–antibody screening test (STRATIFY JCV TM) has been incorporated into a risk–stratification algorithm, presented to patients to help guide treatment. Influence of antibody testing on risk perception and decision to proceed with treatment has not been widely established. Aim To examine treatment decisions of patients receiving natalizumab based on their JCv–antibody status. Patients and methods Serum JCv–antibodies tested annually in patients receiving natalizumab for HARRMS. Clinical data and decisions to stop natalizumab based on JCv status recorded. Results JCv antibody status was available in 112 natalizumab patients. Mean natalizumab duration 27.4 months (2–72). Antibodies detected in 55 (49.1%): 2 (3.6%) stopped due to JCv+ve alone, 14 (25.5%) due to prolonged therapy (>2years), 1 (1.8%) due to prolonged therapy and past immuosuppression, 3 (5.5%) disability progression, 1 (1.8%) to conceive. (12.3% of JCv negative patients stopped due to prolonged therapy). No significant difference in mean natalizumab duration or disease–modifying therapy history between JCv Ab+ve and Ab–ve groups (p>0.05). Other PML risks (>2 years, past immunosuppression) did not differ significantly between JCv+ve patients who opted to continue compared to those choosing to stop (p>0.05). Discussion JCv antibody status had little influence on this cohort's decision to discontinue or remain on natalizumab therapy. It is important that patients understand therapeutic benefits and potential risks of alternative treatments before discontinuing due to JCv status alone. Further validation of this risk stratification measure is important.