title: Natalizumab treatment for multiple sclerosis: updates and considerations for safer treatment in JCV positive patients.
abstract: Natalizumab is currently one of the best options for treatment of patients with Multiple Sclerosis who have failed traditional prior therapies. However, prolonged use, prior immunosuppressive therapy and anti-JCV antibody status have been associated with increased risk of developing progressive multifocal leukoencephalopathy (PML). The evaluation of these conditions has been used to estimate risks of PML in these patients, and distinct (sometimes extreme) approaches are used to avoid the PML onset. At this time, the biggest issue facing the use of Natalizumab is how to get a balance between the risks and the benefits of the treatment. Hence, strategies for monitor JCV-positive patients undergoing Natalizumab treatment are deeply necessary. To illustrate it, we monitored JCV/DNA in blood and urine of a patient receiving Natalizumab for 12 months. We also bring to discussion the effectiveness of the current methods used for risk evaluation, and the real implications of viral reactivation.
authors.affiliation: Departamento de Moléstias Infecciosas e Parasitárias, Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Luiz Henrique da Silva
authors.initials: LH
authors.lastname: Nali
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Lenira
authors.initials: L
authors.lastname: Moraes
authors.affiliation: Departamento de Moléstias Infecciosas e Parasitárias, Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Maria Cristina Domingues
authors.initials: MC
authors.lastname: Fink
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Dagoberto
authors.initials: D
authors.lastname: Callegaro
authors.affiliation: Departamento de Moléstias Infecciosas e Parasitárias, Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Camila Malta
authors.initials: CM
authors.lastname: Romano
authors.affiliation: Instituto de Infectologia Emilio Ribas, Sao Paulo, SP, Brazil.
authors.forename: Augusto Cesar Penalva de
authors.initials: AC
authors.lastname: Oliveira
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D004279:DNA, Viral; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007577:JC Virus / Q000235:genetics / Q000276:immunology*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000276:immunology / Q000821:virology*; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000276:immunology*; D000069442:Natalizumab; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D000069442:Natalizumab