Hervás José Vicente, Presas-Rodríguez Silvia, Crespo-Cuevas Ane Miren, Canento Tamara, Lozano-Sánchez Manuel, Massuet-Vilamajó Anna, Ramo-Tello Cristina
Department of Neurosciences, Multiple Sclerosis Unit, Germans Trias i Pujol Hospital. C/Canyet s/n 08916, Badalona, Spain.
Neurodegener Dis Manag. 2015 Oct;5(5):399-402. doi: 10.2217/nmt.15.42. Epub 2015 Oct 30.
A risk for developing progressive multifocal leukoencephalopathy is a major barrier to natalizumab use. Extended dosing intervals have been proposed as a way to maintain therapeutic efficacy and reduce progressive multifocal leukoencephalopathy incidence. This is the first reported case of progressive multifocal leukoencephalopathy in a patient using an extended dosing regimen (300 mg/6 weeks). A close clinical and imaging monitoring allowed early detection, which is a major prognostic factor. A favorable outcome was seen with a therapy comprising plasma exchange therapy, mirtazapine, mefloquine and cidofovir. Further studies will be needed to assess the potential role of extended dosing intervals to improve prognosis in patients receiving natalizumab and also to measure its impact clinically and/or radiologically.
发生进行性多灶性白质脑病的风险是使用那他珠单抗的主要障碍。延长给药间隔已被提议作为维持治疗效果和降低进行性多灶性白质脑病发病率的一种方法。这是首例报道的使用延长给药方案（300mg/6周）的患者发生进行性多灶性白质脑病的病例。密切的临床和影像学监测实现了早期检测，这是一个主要的预后因素。采用包括血浆置换疗法、米氮平、甲氟喹和西多福韦的治疗方案取得了良好的效果。需要进一步研究以评估延长给药间隔对接受那他珠单抗治疗的患者改善预后的潜在作用，并衡量其在临床和/或影像学方面的影响。
