10. Natalizumab in patients with multiple sclerosis. progressive multifocal leukoencephalopathy – A case report

Abstract

Background Multiple sclerosis still remains a severe neurologic problem, though in last years a tremendous progress in diagnostics and therapy was achieved. On the evidence of randomized controlled studies it was documented, that only early beginning of immune modulating therapy with subsequent further escalation therapy can slow down and even stop the activity of the disease. The decreased activity can postpone or stop the development of disability and conversion to a chronic progressive form of multiple sclerosis. The immune modulating therapy is most effective in the first five years of multiple sclerosis. Natalizumab (Tysabri) is humanized monoclonal antibody approved for the therapy of remitting-relapsing form of multiple sclerosis. Therapy with natalizumab is effective in patients with high disease activity and is able to reduce the number of relapses by 68% in comparison with placebo. This therapy is associated with a couple of adverse effects, the most important is progressive multifocal leukencephalopathy. Methods In a retrospective study we evaluated patients treated with natalizumab in our MS Centre. Results In MS Centre of Department of neurology in Pardubice we register and treat 950 patients with MS, 470 of them are on disease modulating therapy. There are 94 patients on natalizumab, 68 females and 26 males, 18–60 years old, median 31 years, the length of treatment with natalizum till 48 months. We analyzed the effects of treatment, proper indication of such treatment escalation, and adverse events. We presented a case report of 45-year old woman, in whom subclinical MRI changes disclosed progressive multifocal leukoencephalopathy and subsequent development of severe clinical course of this disease, including immune reconstitution inflammatory syndrome (IRIS). Conclusion Therapy with natalizumab is very effective in patients with remitting relapsing multiple sclerosis. This therapy is expensive, the indications are restricted, and is associated with severe adverse events.