Contributions
Abstract: EP1431
Type: ePoster
Abstract Category: Pathology and pathogenesis of MS - MS and infections
Background: The main concern regarding patients receiving natalizumab is the development of leukoencephalopathy (PML), caused by reactivation of a latent JC polyomavirus. However, although extremely rare, other opportunistic viral infections have been described, particularly herpes simplex virus (HSV) and varicella zoster virus (VZV) meningitis and encephalitis. In multiple sclerosis clinical trials a small excess of herpes infections in patients on natalizumab was described, while post-marketing studies reported discrepant results.
Methods: Clinical features and neurologic history from two patients receiving natalizumab and regularly followed in our multiple sclerosis out-patient clinic were reviewed in details.
Results: Two female patients with a diagnosis of relapsing remitting multiple sclerosis, 32 and 45 years-old, were started on natalizumab treatment, after ineffective treatment with beta-interferon and glatiramer acetate. EDSS of patients was 2.5 and 1.5. After 50 and 68 infusions respectively, both patients developed recurrent herpes labials characterized by the usual course of the disease, but followed by the reappearance of the classical skin lesion few days after recovery. Orally administrated acyclovir was effective in the treatment of the acute phase and prevented subsequent reactivations, but one of the patients, after spontaneous withdrawal of the drug, developed corneal herpes, requiring beneficial parenteral treatment, in the absence of local complications. Both patients were anti-JCV antibodies positive. Given the acquired tendency of the patients to manifest symptoms of peripheral HSV reactivation, the possible consequences of corneal involvement, and the anti-JCV positivity, Natalizumab was discontinued.
Conclusions: This report highlight the possibility of non central nervous system infections in patients receiving natalizumab, extending the spectrum of known infective complications. In our view HSV reactivations during treatment with disease-modifying agents must be taken in particular consideration, given the possible complications of the reactivation itself (permanent loss of visual acuity due to cheratitis) and their yet not clarified association with subsequent CNS involvement, rising questions about indications on drug discontinuation or switch.
Disclosure: I. Callegari: nothing to disclose
A. Cortese reports travel grants from Pfizer, ISIS-Pharmaceuticals, Alnylam Pharmaceuticals and received honoraria from Pfizer for lectures.
G. Mallucci received support to travel to scientific meetings from Bayer Schering, Biogen Idec, Genzyme, Merck Serono, Novartis, Sanofi-Aventis, Teva.
E. Vegezzi: nothing to disclose
M. Gastaldi: nothing to disclose
D. Franciotta: nothing to discolse
R. Bergamaschi received speaker honoraria from Bayer Schering, Biogen, Novartis, Sanofi-Aventis, Teva; research grants from Bayer Schering, Biogen, Novartis, Sanofi-Aventis, Teva; congress and travel expense compensations from Bayer Schering, Biogen, Novartis,
Sanofi-Aventis, Teva
A. Romani: nothing to discolse
Abstract: EP1431
Type: ePoster
Abstract Category: Pathology and pathogenesis of MS - MS and infections
Background: The main concern regarding patients receiving natalizumab is the development of leukoencephalopathy (PML), caused by reactivation of a latent JC polyomavirus. However, although extremely rare, other opportunistic viral infections have been described, particularly herpes simplex virus (HSV) and varicella zoster virus (VZV) meningitis and encephalitis. In multiple sclerosis clinical trials a small excess of herpes infections in patients on natalizumab was described, while post-marketing studies reported discrepant results.
Methods: Clinical features and neurologic history from two patients receiving natalizumab and regularly followed in our multiple sclerosis out-patient clinic were reviewed in details.
Results: Two female patients with a diagnosis of relapsing remitting multiple sclerosis, 32 and 45 years-old, were started on natalizumab treatment, after ineffective treatment with beta-interferon and glatiramer acetate. EDSS of patients was 2.5 and 1.5. After 50 and 68 infusions respectively, both patients developed recurrent herpes labials characterized by the usual course of the disease, but followed by the reappearance of the classical skin lesion few days after recovery. Orally administrated acyclovir was effective in the treatment of the acute phase and prevented subsequent reactivations, but one of the patients, after spontaneous withdrawal of the drug, developed corneal herpes, requiring beneficial parenteral treatment, in the absence of local complications. Both patients were anti-JCV antibodies positive. Given the acquired tendency of the patients to manifest symptoms of peripheral HSV reactivation, the possible consequences of corneal involvement, and the anti-JCV positivity, Natalizumab was discontinued.
Conclusions: This report highlight the possibility of non central nervous system infections in patients receiving natalizumab, extending the spectrum of known infective complications. In our view HSV reactivations during treatment with disease-modifying agents must be taken in particular consideration, given the possible complications of the reactivation itself (permanent loss of visual acuity due to cheratitis) and their yet not clarified association with subsequent CNS involvement, rising questions about indications on drug discontinuation or switch.
Disclosure: I. Callegari: nothing to disclose
A. Cortese reports travel grants from Pfizer, ISIS-Pharmaceuticals, Alnylam Pharmaceuticals and received honoraria from Pfizer for lectures.
G. Mallucci received support to travel to scientific meetings from Bayer Schering, Biogen Idec, Genzyme, Merck Serono, Novartis, Sanofi-Aventis, Teva.
E. Vegezzi: nothing to disclose
M. Gastaldi: nothing to disclose
D. Franciotta: nothing to discolse
R. Bergamaschi received speaker honoraria from Bayer Schering, Biogen, Novartis, Sanofi-Aventis, Teva; research grants from Bayer Schering, Biogen, Novartis, Sanofi-Aventis, Teva; congress and travel expense compensations from Bayer Schering, Biogen, Novartis,
Sanofi-Aventis, Teva
A. Romani: nothing to discolse