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Viruria Could Help Predict Rare Condition in Multiple Sclerosis

JC virus in urine may help identify patients at risk of progressive multifocal leukoencephalopathy

WEDNESDAY, Sept. 9 (HealthDay News) -- Analyzing the urine of multiple sclerosis patients for JC virus could help identify those at risk of developing another rare demyelinating disease after natalizumab (Tysabri) treatment, according to a study in the Sept. 10 issue of the New England Journal of Medicine. And two additional reports detail cases of this rare condition, progressive multifocal leukoencephalopathy (PML).

Yiping Chen, M.D., of Harvard Medical School in Boston, and colleagues followed 19 patients with multiple sclerosis who had been treated with natalizumab over 18 months. The researchers found that the JC virus shed in increasing amounts in urine six to 12 months after starting natalizumab treatment. After 18 months, JC virus was found in 20 percent of available plasma samples and 60 percent of peripheral blood mononuclear cells, although none of the patients developed PML.

In one of two case reports, Werner Wenning, M.D., from Ortenau-Klinikum in Offenburg, Germany, and colleagues describe the case of a 52-year-old man with multiple sclerosis who developed JC virus-associated PML after 12 months of natalizumab therapy. Two months after the onset of neurologic and psychiatric symptoms, the patient was hospitalized and treated with plasma exchange and immunoadsorption to remove natalizumab from his system. He recovered after further steroid-pulse treatment.

"Underscoring the rare nature of PML, regardless of the underlying immune dysfunction with which it is associated, and identifying viral and host risk factors would not only aid us in better selecting patients for immunomodulatory therapies, but would also help to direct research into interventional therapies for PML itself," writes the author of an accompanying editorial.

Abstract - Chen
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