Scarpazza Cristina, Prosperini Luca, Mancinelli Chiara R, De Rossi Nicola, Lugaresi Alessandra, Capobianco Marco, Moiola Lucia, Naldi Paola, Imberti Luisa, Gerevini Simonetta, Capra Ruggero
Multiple Sclerosis Centre, Spedali Civili di Brescia, Via Ciotti 154, 25018 Montichiari, Brescia, Italy.
Department of Neurology and Psychiatry, Sapienza University, Viale Dell'Università, 30, 00185 Rome, Italy.
J Neurol Sci. 2017 Jul 15;378:233-237. doi: 10.1016/j.jns.2017.05.018. Epub 2017 May 12.
Despite the recent advances in the understanding of natalizumab (NTZ) related progressive multifocal leukoencephalopathy (PML) and its associated immune reconstitution inflammatory syndrome (PML-IRIS), the therapeutic options are still under investigated. In this context, the beneficial use of maraviroc is still an anecdotal observation.
To evaluate the impact of maraviroc in modifying the course of PML preventing IRIS or blunting IRIS manifestations.
Three patients with NTZ PML included in the Italian dataset of PML were treated with maraviroc. Their longitudinal clinical and radiological course was described in detail.
The three patients were characterized by a steady clinical worsening not controlled by maraviroc. All the three patients manifested PML-IRIS, which emerged, respectively, at 62, 64 and 90days post NTZ withdrawal. This is in accordance with the data of the Italian dataset. Clinical and radiological stabilization of PML-IRIS occurred only after corticosteroids administration.
In these three cases, maraviroc did not show any clear effect in modulating the clinical course of PML preventing IRIS. Moreover, once PML-IRIS emerged, the clinical stabilization was achieved only with the use of corticosteroids. Thus, the use of maraviroc should be regarded with extreme caution due the potential adverse events associated with its use.
尽管近期在理解那他珠单抗（NTZ）相关的进行性多灶性白质脑病（PML）及其相关的免疫重建炎症综合征（PML-IRIS）方面取得了进展，但治疗选择仍在研究中。在此背景下，马拉维若的有益用途仍只是个别观察结果。
评估马拉维若对改变PML病程、预防IRIS或减轻IRIS表现的影响。
意大利PML数据集中纳入的3例NTZ相关PML患者接受了马拉维若治疗。详细描述了他们的纵向临床和影像学病程。
这3例患者的特点是临床持续恶化，马拉维若无法控制。所有3例患者均出现了PML-IRIS，分别在停用NTZ后62、64和90天出现。这与意大利数据集的数据一致。PML-IRIS的临床和影像学稳定仅在给予皮质类固醇后出现。
在这3例病例中，马拉维若在调节PML病程、预防IRIS方面未显示出任何明显效果。此外，一旦出现PML-IRIS，仅使用皮质类固醇才能实现临床稳定。因此，鉴于使用马拉维若可能产生不良事件，应极其谨慎地使用。
