Objective: To examine retrospectively the effects of plasmapheresis (PLEX) on the survival andclinical outcomes of patients with multiple sclerosis (MS) and natalizumab (NTZ)–associatedprogressive multifocal leukoencephalopathy (PML).Methods: The medical literature was searched for the terms natalizumab and progressive multifocalleukoencephalopathy. A total of 193 international and 34 Italian NTZ-PML cases wereincluded. Clinical outcome was determined by comparing the patients’ clinical status at PMLdiagnosis 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, priorimmunosuppressant exposure, PML symptoms, PML lesion location at diagnosis, CSF JC virusstatus and copies, additional PML treatments and steroids, and PML immune reconstitutioninflammatory syndrome (IRIS) development were investigated with both univariate and multivariateanalyses.Results: A total of 219 NTZ-PML cases were analyzed, and 184 (84%) underwent PLEX, which didnot reduce the mortality risk or the likelihood of poor vs favorable outcomes. Country was predictiveof 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 patientswith MS and NTZ-PML, suggesting that this treatment should be performed cautiously inthe 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 importantbenefit or harm of PLEX.
|Numero di pagine||9|
|Stato di pubblicazione||Published - 2017|