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Progressive multifocal leucoencephalopathy

Andreas Kronbichler, Martin Windpessl, Herwig Pieringer, David R W Jayne
Rituximab (RTX), a chimeric, monoclonal anti-CD20 antibody, is increasingly used in immune-mediated renal diseases. While licensed in the induction treatment of ANCA-associated vasculitis, it represents one of the most commonly prescribed off-label drugs. Much of the information regarding its safety has been drawn from experience in hematology and rheumatology. Ample evidence illustrates the safety of RTX, however, rare but serious adverse events have emerged that include progressive multifocal leucoencephalopathy and hepatitis B reactivation...
April 13, 2017: Autoimmunity Reviews
Mark S Igra, David Paling, Mike P Wattjes, Daniel Ja Connolly, Nigel Hoggard
MRI has long been established as the most sensitive in vivo technique for detecting multiple sclerosis (MS) lesions. The 2010 revisions of the McDonald Criteria have simplified imaging criteria, such that a diagnosis of MS can be made on a single contrast-enhanced MRI scan in the appropriate clinical context. New disease modifying therapies have proven effective in reducing relapse rate and severity. Several of these therapies, most particularly natalizumab, but also dimethyl fumarate and fingolimod have been associated with progressive multifocal leucoencephalopathy (PML)...
March 31, 2017: British Journal of Radiology
Kim Dao, Haithem Chtioui, Laura E Rothuizen, Léonore Diezi, Sylvain Prod'hom, Ursula Winterfeld, Thierry Buclin, Françoise Livio
The main pharmacovigilance updates in 2015are reviewed. Sofosbuvir amiodarone interaction: risk of severe bradycardia. Dasabuvir clopidogrel interaction: increased dasabuvir concentrations and potential risk of QTprolongation. SGLT2 inhibitors: risks of diabetic acidocetosis and bone fracture. Dabigatran: therapeutic drug monitoring may improve benefit-risk ratio. Ibuprofen: at higher dosage, vascular risks are comparable to coxibs. Pregabaline, gabapentine: potential for abuse and addiction. Varenicline: potentiates alcohol's effects...
January 13, 2016: Revue Médicale Suisse
S Sainz-de-la-Maza, J L Casado, M J Pérez-Elías, A Moreno, C Quereda, S Moreno, I Corral
BACKGROUND AND PURPOSE: Progressive multifocal leucoencephalopathy-associated immune reconstitution inflammatory syndrome (PML-IRIS) is the paradoxical worsening or unmasking of preexisting infection with JC virus attributable to a rapid recovery of the immune system after highly active antiretroviral therapy (HAART) initiation. We investigated the incidence and factors associated with PML-IRIS in HIV-infected patients. We also studied its influence on mortality of PML and the effect of corticosteroid therapy...
May 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Jean-Frédéric Colombel, Bruce E Sands, Paul Rutgeerts, William Sandborn, Silvio Danese, Geert D'Haens, Remo Panaccione, Edward V Loftus, Serap Sankoh, Irving Fox, Asit Parikh, Catherine Milch, Brihad Abhyankar, Brian G Feagan
OBJECTIVE: Vedolizumab is a gut-selective antibody to α4β7 integrin for the treatment of ulcerative colitis (UC) and Crohn's disease (CD). We report an integrated summary of the safety of vedolizumab. DESIGN: Safety data (May 2009-June 2013) from six trials of vedolizumab were integrated. Adverse events were evaluated in patients who received ≥1 dose of vedolizumab or placebo and were reported as exposure-adjusted incidence rates as the number of patients experiencing the event per 100 person-years (PYs) of exposure...
February 18, 2016: Gut
José Tomás, Maria Carmo Macário, Elsa Gaspar, Isabel Santana
Neurological complications of H1N1 infections are mostly found in children, but rare cases of acute encephalopathy and post-infectious encephalitis such as acute disseminated encephalomyelitis (ADEM) have been described in adults. We report a case of an adult presenting with a progressive and severe encephalopathy that developed after H1N1 respiratory infection resolution. Cerebrospinal fluid (CSF) analysis was normal, including negative PCR for herpes simplex virus, H1N1, influenza B and JC virus, and absent oligoclonal IgG bands in CSF and serum...
October 22, 2015: BMJ Case Reports
Md Yuzaiful Md Yusof, Edward M Vital, Maya H Buch
The development of B cell-targeted biologics represents a major advance in the treatment of autoimmune rheumatic diseases. As with other immunosuppressive agents, risk of infection is a key clinical concern. This review summarises safety data from 15 years of experience of rituximab in autoimmune diseases with a particular focus on opportunistic infection and class-specific complications and infection risk. Rarely, cases of progressive multifocal leucoencephalopathy in rituximab-treated patients (5/100 000) have accumulated over time although no proven causal association has yet been shown...
October 2015: Current Rheumatology Reports
Ana P Sousa, Paulo Santos, Claudia Fernandes, Rui Pedrosa
No abstract text is available yet for this article.
June 2015: Arquivos de Neuro-psiquiatria
Sarah Campbell, Avinash Kumar Kanodia, Jonathan O'Riordan
No abstract text is available yet for this article.
April 15, 2015: BMJ Case Reports
R E Ferner
Adverse drug reactions (ADRs) - that is, unintended and harmful responses to medicines - are important to dermatologists because many present with cutaneous signs and because dermatological treatments can cause serious ADRs. The detection of ADRs to new drugs is often delayed because they have a long latency or are rare or unexpected. This means that ADRs to newer agents emerge only slowly after marketing. ADRs are part of the differential diagnosis of unusual rashes. A good drug history that includes details of drug dose, time-course of the reaction and factors that may make the patient more susceptible, will help...
March 2015: Clinical and Experimental Dermatology
Mária Karácsony, Krisztina Bencsik, László Vécsei
Multiple sclerosis (MS) is the most common chronic disease of the central nervous system in young adults. No curative therapy is known. Currently, six drugs are available that can reduce the activity of MS. The first-line drugs can completely reduce the activity of the disease in nearly two-thirds of the patients. In the remainder, who suffer from breakthrough disease, the condition of the patient worsens, and second-line therapies must be used. The second-line drug natalizumab exhibits almost double efficacy of the first-line drugs, but also have less favourable adverse effects...
July 30, 2014: Ideggyógyászati Szemle
Fatima Dhalla, Sarah Murray, Ross Sadler, Benjamin Chaigne-Delalande, Tomohiko Sadaoka, Elizabeth Soilleux, Gulbu Uzel, Joanne Miller, Graham Peter Collins, Christian Simon Ross Hatton, Malini Bhole, Berne Ferry, Helen M Chapel, Jeffrey I Cohen, Smita Y Patel
XMEN disease (X-linked immunodeficiency with Magnesium defect, Epstein-Barr virus infection and Neoplasia) is a novel primary immune deficiency caused by mutations in MAGT1 and characterised by chronic infection with Epstein-Barr virus (EBV), EBV-driven lymphoma, CD4 T-cell lymphopenia, and dysgammaglobulinemia [1]. Functional studies have demonstrated roles for magnesium as a second messenger in T-cell receptor signalling [1], and for NKG2D expression and consequently NK- and CD8 T-cell cytotoxicity [2]. 7 patients have been described in the literature; the oldest died at 45 years and was diagnosed posthumously [1-3]...
February 2015: Journal of Clinical Immunology
Anna Jamroz-Wiśniewska, Jacek Jaworski, Dorota Suszek, Marzena Janczarek, Zbigniew Stelmasiak, Konrad Rejdak, Halina Bartosik-Psujek
We present a case of a 30-year-old Polish female who presented with increasing for about 2 years spastic paraparesis and urinary incontinence. She denied any risky sexual behaviors, drug abuse, there was no history of surgery or blood transfusions. MRI of the brain showed diffuse, hyperintensive in T2, poorly defined lesions in the white matter. About 3 months later paraparesis increased and control MRI showed progression of previously described lesions. She was then diagnosed with HIV infection. There was a suspicion of progressive multifocal leucoencephalopathy (PML) or vacuolar myelopathy in the course of HIV infection...
2014: Neurologia i Neurochirurgia Polska
Maria-Eleptheria Evangelopoulos, Vasilios Koutoulidis, Kostas Kilidireas, Dimitrios-Stergios Evangelopoulos, Georgios Nakas, Elisabeth Andreadou, Lia-Angela Moulopoulos
Natalizumab (NTM) represents an effective drug for the treatment of relapsing-remitting multiple sclerosis (RRMS). Progressive multifocal leucoencephalopathy (PML) is a potential life-threatening complication of NTM treatment. A close follow-up and MRI monitoring of patients under NTM are required to avoid such devastating complications. The case of a 47-year-old woman with RRMS (EDSS 1.5) treated with NTM for 44 months is reported. The patient had a relapse with mild cerebellar symptomatology and visual complaints...
January 2015: Journal of Clinical Medicine Research
R Alroughani, A Almulla, S Lamdhade, A Thussu
Although few recent studies have reported efficacy and safety data among patients with multiple sclerosis (MS) switching between immunotherapies, data on the mechanism of rebound activity postwithdrawal of fingolimod in patients with MS is scarce. A 36-year-old woman developed severe reactivation of her disease within 7 weeks of fingolimod's withdrawal despite the absence of breakthrough disease during the 8-week natalizumab washout period previously. The clinical presentation and radiological features were described indicating the diagnostic challenge given the potential risk of developing progressive multifocal leucoencephalopathy...
2014: BMJ Case Reports
Asta Theódórsdóttir, Morten Blaabjerg, Masoud Falah
A 41-year-old woman with relapsing-remitting multiple sclerosis came to the outpatient-clinic, prior to a scheduled infusion with natalizumab. She had been treated with natalizumab for four years. Prior to treatment she did not wish to have her John Cunningham virus status tested. At the consultation she appeared disoriented and answered questions inadequately. An MRI was consistent with progressive multifocal leucoencephalopathy, and treatment with plasmapheresis was startet immediatly. The patient deceased four months later...
August 25, 2014: Ugeskrift for Laeger
S Salhofer-Polanyi, A Baumgartner, J Kraus, E Maida, M Schmied, F Leutmezer
BACKGROUND: To minimize the risk of progressive multifocal leucoencephalopathy (PML), treatment with natalizumab is often stopped after 2 years, but evidence upon rebound of disease activity is limited and controversial. OBJECTIVE: To evaluate effects of natalizumab discontinuation on clinical disease activity within twelve months after cessation. METHODS: We retrospectively analyzed data of 201 patients with MS who discontinued natalizumab between 2007 and 2012...
August 2014: Acta Neurologica Scandinavica
Léonore Diezi, Delphine Renard, Laura E Rothuizen, Françoise Livio
The main pharmacovigilance updates in 2013 are reviewed. Nitrofurantoin: lower efficacy and an increased risk of adverse events when creatinine clearance is below 60 ml/min. Dabigatran: contraindicated in patients with mechanical heart valves. Azithromycin: QT prolongation and increased risk of death. Zolpidem: towards a lower dosage. Roflumilast: avoid in patients known or at risk for mood disorders. Retigabine: indication restricted to last-line use and new monitoring requirements after reports of pigment changes in retina and other tissues...
January 15, 2014: Revue Médicale Suisse
Helmut Butzkueven, Ludwig Kappos, Fabio Pellegrini, Maria Trojano, Heinz Wiendl, Radhika N Patel, Annie Zhang, Christophe Hotermans, Shibeshih Belachew
BACKGROUND: Clinical trials established the efficacy and safety of natalizumab. Data are needed over longer periods of time and in the clinical practice setting. OBJECTIVE: To evaluate long-term safety of natalizumab and its impact on annualised relapse rate and Expanded Disability Status Scale (EDSS) progression in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: The Tysabri (natalizumab) Observational Program (TOP) is an open-label, multinational, 10-year prospective study in clinical practice settings...
November 2014: Journal of Neurology, Neurosurgery, and Psychiatry
Khalid Ali, Reem Amin, Kathir G Yoganathan, Rob Powell
Progressive multifocal leucoencephalopathy (PML) is a severe demyelinating disease of the central nervous system that is caused by the JC virus infection. It is often fatal or severely disabling. PML exclusively happens in the context of cell-mediated immunosuppression. Prior to the era of HIV, PML was mainly confined to patients with haematological malignancies and rheumatological diseases. The HIV epidemic in the early eighties led to massive expansion in the incidence and prevalence of the disease. PML has also been recognised to happen due to treatment with monoclonal antibodies such as natalizumab, which is used as a disease-modifying agent for relapsing remitting multiple sclerosis and other monoclonal antibodies used in dermatological and haematological conditions...
2013: BMJ Case Reports
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