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Progressive multifocal leukoencephalopathy associated to natalizumab extended dosing regimen

    José Vicente Hervás

    Department of Neurosciences, Multiple Sclerosis Unit, Germans Trias i Pujol Hospital. C/Canyet s/n 08916, Badalona, Spain

    ,
    Silvia Presas-Rodríguez

    Department of Neurosciences, Multiple Sclerosis Unit, Germans Trias i Pujol Hospital. C/Canyet s/n 08916, Badalona, Spain

    ,
    Ane Miren Crespo-Cuevas

    Department of Neurosciences, Multiple Sclerosis Unit, Germans Trias i Pujol Hospital. C/Canyet s/n 08916, Badalona, Spain

    ,
    Tamara Canento

    Department of Neurosciences, Multiple Sclerosis Unit, Germans Trias i Pujol Hospital. C/Canyet s/n 08916, Badalona, Spain

    ,
    Manuel Lozano-Sánchez

    Department of Neurosciences, Multiple Sclerosis Unit, Germans Trias i Pujol Hospital. C/Canyet s/n 08916, Badalona, Spain

    ,
    Anna Massuet-Vilamajó

    Department of Neurosciences, Multiple Sclerosis Unit, Germans Trias i Pujol Hospital. C/Canyet s/n 08916, Badalona, Spain

    &
    Cristina Ramo-Tello

    *Author for correspondence:

    E-mail Address: cramot@gmail.com

    Department of Neurosciences, Multiple Sclerosis Unit, Germans Trias i Pujol Hospital. C/Canyet s/n 08916, Badalona, Spain

    Published Online:https://doi.org/10.2217/nmt.15.42

    A risk for developing progressive multifocal leukoencephalopathy is a major barrier to natalizumab use. Extended dosing intervals have been proposed as a way to maintain therapeutic efficacy and reduce progressive multifocal leukoencephalopathy incidence. This is the first reported case of progressive multifocal leukoencephalopathy in a patient using an extended dosing regimen (300 mg/6 weeks). A close clinical and imaging monitoring allowed early detection, which is a major prognostic factor. A favorable outcome was seen with a therapy comprising plasma exchange therapy, mirtazapine, mefloquine and cidofovir. Further studies will be needed to assess the potential role of extended dosing intervals to improve prognosis in patients receiving natalizumab and also to measure its impact clinically and/or radiologically.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

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