Does extended interval of natalizumab dosing decrease the risk of progressive multifocal leukoencephalopathy? – case report Review article
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Abstract
Natalizumab, a humanized monoclonal antibody against the α4-integrin, has high efficacy in the treatment of relapsing-remitting multiple sclerosis. The drug is generally very well tolerated. However, the long-term therapy brings an increasing risk of developing progressive multifocal leukoencephalopathy, an opportunistic infection caused by the JC virus (JCV). The authors present a case of 53-year-old patient suffering from relapsing-remitting multiple sclerosis, with positive JCV serostatus, treated with natalizumab for 14 years. During natalizumab treatment disease activity was not observed. However, in the thirteenth year of therapy a sustained increase in the anti-JC antibody index from 0.72 to 1.31 was noticed. In order to minimize the risk of side effects of treatment, radiological monitoring was intensified and the strategy of extended interval of drug dosing was introduced – the interval between consecutive doses of natalizumab was prolonged from 4 to 6 weeks. The modification of treatment schedule did not affect the high effectiveness of therapy. Within 12 months from the prolongation between drug doses there were no relapses, no disability progression and no active demyelinating lesions observed in regularly performed magnetic resonance imaging of the brain. But, it was found a decrease in the anti-JCV antibody index in patient’s serum to a safe value of 0.77.
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