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Mild progressive multifocal leukoencephalopathy after switching from natalizumab to ocrelizumab

Toorop, AA; Van Lierop, ZYG; Strijbis, EEM; Teunissen, CE; Petzold, A; Wattjes, MP; Barkhof, F; ... Killestein, J; + view all (2021) Mild progressive multifocal leukoencephalopathy after switching from natalizumab to ocrelizumab. Neurology: Neuroimmunology & Neuroinflammation , 8 (1) , Article e904. 10.1212/NXI.0000000000000904. Green open access

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Abstract

OBJECTIVE: To describe the disease course of carryover progressive multifocal leukoencephalopathy (PML) after switching from natalizumab to ocrelizumab in 2 patients with relapsing-remitting MS. METHODS: Two case reports with 1 year of follow-up and retrospective longitudinal measurements of serum neurofilament light (NfL) levels and B-cells. RESULTS: PML was diagnosed 78 days (case 1) and 97 days (case 2) after discontinuation of natalizumab. Both patients developed mild immune reconstitution inflammatory syndrome (IRIS) despite B-cell depletion caused by ocrelizumab. NfL levels increased in both patients during PML-IRIS. PML-IRIS lesions stabilized after treatment with mefloquine and mirtazapine, followed by methylprednisolone, and both patients continued therapy with ocrelizumab when B-cells started to repopulate. CONCLUSIONS: The clinical course of carryover PML was mild in both patients, suggesting that B-cell depletion possibly did not aggravate PML-IRIS in these 2 patients.

Type: Article
Title: Mild progressive multifocal leukoencephalopathy after switching from natalizumab to ocrelizumab
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1212/NXI.0000000000000904
Publisher version: https://doi.org/10.1212/NXI.0000000000000904
Language: English
Additional information: Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Keywords: Multiple sclerosis
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Brain Repair and Rehabilitation
URI: https://discovery.ucl.ac.uk/id/eprint/10113290
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