Natalizumab therapy is associated with changes in serum JC virus antibody indices over time

Abstract

To examine changes in anti-JC Virus (JCV) index measurements over time in multiple sclerosis (MS) patients to better understand this test, which is used in assessing risk of progressive multifocal leukoencephalopathy (PML) with natalizumab. We aim to describe and compare seroconversion rates, variability of JCV antibody index values, and changes in index values over time between patients on natalizumab therapy and patients naïve to natalizumab. Anti-JCV index values are used to help decide whether to start, continue, or stop treatment. Assessing how index values vary over time is interpreted to allow a patient's risk of PML to be better characterized. Retrospective analysis was conducted using records of patients with multiple JCV antibody index measurements exposed to therapy with natalizumab (N=150) or not (N=145). Rates of seroconversion, variability of indices, and changes in index values over time were calculated and compared. Patients on natalizumab who were initially JCV antibody negative seroconverted at a significantly higher rate than patients naïve to natalizumab (23.9 vs. 9.1%, p<0.01). Variability of anti-JCV indices was also found to be significantly higher for patients on natalizumab (p<0.05). Patients on natalizumab additionally trended towards a larger increase in index values over time. Therapy with natalizumab was associated with higher rates of seroconversion and greater anti-JCV index variability, suggesting that therapy with natalizumab may influence this test used to assess risk of treatment with it.