在意大利Natalizumab-related PML多发性硬化症患者。MS-PML意大利集团的研究报告(P4.034)

文摘

目的:确定安全仪器,在意大利,natalizumab患者预后指标。背景:没有共同的共识在长期natalizumab治疗PML风险的监控。选择和诊断测试的时机及其相关PML临床结果是至关重要的。设计方法:20意大利女士中心共享数据的25/26 natalizumab-related PML的病例。人口和核磁共振数据,以前的治疗(s)女士,eds, Karnofsky得分,JCV抗体状态,natalizumab注入都被记录下来。结果:JCV血清学阳性的20/25的病人,而不是测试5/25(分层测试没有可用)。PML发生在治疗24月8/25例(32 [percnt]), 25间th-36th月8/25,37 th-48th月3/25 (12 [percnt]),在48个月6/25 (24 [percnt])。PML临床(18/25)或MRI诊断是由于怀疑(7/25)。MRI病灶是单身(16/25,64 [percnt]),多个(9/25,36 [percnt]),皮层下(16/25,64 [percnt])。钆增强观察病变36 [percnt],没有相关的临床恶化。 A lower MRI lesion load was correlated to a better prognosis. Clinical symptoms at onset were cognitive-behavioural (10/18, 40[percnt]), motor (5/18, 20[percnt]), other (seizures, dystonia, myoclonic jerks: 6/18, 24[percnt]). Onset with motor symptoms was associated with a longer diagnostic delay than cognitive symptoms (mean: 25 vs 75 days). Karnofsky score and EDSS worsened steadily during PML course peaking at 6th month, then disability gradually decreased. A higher number of CSF virus copies was significantly correlated to the worse clinical course and death (2/25). Natalizumab infusions after PML was suspected represent a negative prognostic factor. Conclusions: any new clinical sign observed during natalizumab treatment must raise the suspect of PML. MRI has to be considered a safety exam and should be followed by lunbar puncture to enhance prompt diagnosis. Lower lesion load and number of CSF-JCV copies are correlated to better clinical outcome.

披露:Cordioli博士已经收到个人补偿活动和Genzyme生原体Idec。德罗西博士已经收到个人活动与Teva补偿。Gerevini博士没有披露。阿马托博士已经收到个人活动与补偿Idec,默克公司Serono, Inc .)、拜耳、诺华、Teva神经科学,赛诺菲-安万特(sanofi - aventis) Genzyme, Almirall扬声器和/或顾问。阿马托博士收到生原体研究支持我电影博士没有披露。Cavalla博士没有披露。Capobianco博士已经收到个人活动与补偿Idec, Sanofi-Genzyme,诺华,默克公司Serono, Teva担任顾问和/或扬声器。Deotto博士已经收到个人活动与拜耳补偿,默克公司Serono, Teva,诺华、Idec,和Almirall。博士德Riz没有披露。法拉利博士没有披露。 Dr. Fusco has nothing to disclose. Dr. Ghezzi has received personal compensation for activities with Merck Serono, Novartis, Biogen Idec, Teva, Bayer Schering, Sanofi-Genzyme, Serono, and Almirall as an advisory board member and/or speaker. Dr. Grimaldi has nothing to disclose. Dr. Lugaresi has received personal compensation for activities with Bayer Schering, Biogen Idec, Merck Serono, Genzyme, Sanofi-Aventis Pharmaceuticals, and Teva Neuroscience. Dr. Moiola has received personal compensation for activities with Biogen Idec, Sanofi-Aventis Pharmaceuticals, and Merck Serono as a speaker, Dr. Perrone has nothing to disclose. Dr. Prosperini has received personal compensation for activities with Bayer Schering, Biogen Idec, Genzyme, Novartis, and Teva Neuroscience. Dr. Rezzonico has received personal compensation for activities with IMS Health, McCann Complete Medical, Biogen Idec, Serono, Inc., Bayer Pharmaceuticals Corporation, Teva Neuroscience, Novartis, Aventis Pharmaceuticals Inc., and Baxter International. Dr. Rovaris has received personal compensation for activities with Almirall, Bayer Schering Pharma, Biogen Idec, Novartis, Teva Neuroscience. Dr. Salemi has received research support from Merck Serono, Biogen Idec, Teva Neuroscience, Novartis, Bayer, and Sanofi-Aventis. Dr. Salvetti has received personal compensation for activities with Sanofi-Aventis, Biogen Idec, Bayer Schering, and Merck Serono. Dr. Salvetti has received research support from Sanofi-Aventis, Biogen Idec, Bayer Schering, Merck Serono, and the Italian M Dr. Solaro has received personal compensation for activities with Biogen Idec, Merck Serono, Bayer Schering Pharma, Almirall, Teva Neuroscience, and Genzyme Corporation as an advisory board participant and/or speaker. Dr. Solaro has received research supp Dr. Tortorella has nothing to disclose. Dr. Capra has received personal compensation for activities with Biogen Idec, Sanofi-Aventis, and Novartis as a lecturer and/or consultant.