Contributions
Abstract: 202
Type: Oral
Progressive multifocal leukoencephalopathy (PML) has become a significant driver of risk considerations in treatment of multiple sclerosis in recent years. Natalizumab is now recognized to be associated with a serious risk of PML, making consideration of this a major concern for MS clinicians. Current understanding of natalizumab associated PML risk will be reviewed including the impact of prior therapies, duration of therapy, and the status of JC virus exposure. Use of risk stratification to design optimal monitoring of patients during natalizumab therapy will be discussed. In the highest risk subpopulation, risk of PML may exceed 1 in 70 exposed patients. PML diagnosis and therapy will be addressed in the setting of multiple sclerosis therapies. Additionally, subsequent to recognition of PML in natalizuamb treated patients, additional therapies for which concern of PML exists include dimethyl fumarate and fingolimod treated patients, as well as concerns generated by PML seen in other settings associated with rituximab and alemtuzumab. Recommendations on monitoring and selection of these therapies relative to PML will also be discussed.
Disclosure: Dr Clifford serves on data safety, monitoring boards, or consultative roles with Biogen, Inhibikase, Genzyme/Sanofi, Takeda, Genentech/Roche, Pfizer, Dr Reddy, Amgen, Wave, and Shire, while receiving support from NIH NIAID, NIA, NIMH, and Alzheimer Association, and on studies supported by Janssen, Roche and Lilly.
Abstract: 202
Type: Oral
Progressive multifocal leukoencephalopathy (PML) has become a significant driver of risk considerations in treatment of multiple sclerosis in recent years. Natalizumab is now recognized to be associated with a serious risk of PML, making consideration of this a major concern for MS clinicians. Current understanding of natalizumab associated PML risk will be reviewed including the impact of prior therapies, duration of therapy, and the status of JC virus exposure. Use of risk stratification to design optimal monitoring of patients during natalizumab therapy will be discussed. In the highest risk subpopulation, risk of PML may exceed 1 in 70 exposed patients. PML diagnosis and therapy will be addressed in the setting of multiple sclerosis therapies. Additionally, subsequent to recognition of PML in natalizuamb treated patients, additional therapies for which concern of PML exists include dimethyl fumarate and fingolimod treated patients, as well as concerns generated by PML seen in other settings associated with rituximab and alemtuzumab. Recommendations on monitoring and selection of these therapies relative to PML will also be discussed.
Disclosure: Dr Clifford serves on data safety, monitoring boards, or consultative roles with Biogen, Inhibikase, Genzyme/Sanofi, Takeda, Genentech/Roche, Pfizer, Dr Reddy, Amgen, Wave, and Shire, while receiving support from NIH NIAID, NIA, NIMH, and Alzheimer Association, and on studies supported by Janssen, Roche and Lilly.