title: Treatment of Progressive Multifocal Leukoencephalopathy With Mirtazapine.
abstract: OBJECTIVE
  Progressive multifocal leukoencephalopathy (PML) is a rare, JC-virus-mediated, demyelinating disease with a high mortality rate. As no recommended treatment exists, mirtazapine, a potential blocker of virus entry into cells, has been empirically used.
  
  
  METHODS
  We analysed existing data on mirtazapine's efficacy to treat PML by systematically reviewing the literature since 2005, when it was first used.
  
  
  RESULTS
  Searches in PubMed, EBSCO, SCOPUS and Google Scholar between January 2005 and December 2015, identified five cohort studies and 74 case reports. No statistically significant effect of mirtazapine on PML outcome was observed in the cohort studies. From studying the case reports, mortality rate for PML was associated with the underlying circumstances, such as an older age, the use of an immunosuppressant, or PML occurring in patients with a haematological malignancy or a transplant.
  
  
  CONCLUSIONS
  Except for natalizumab-associated PML, we did not highlight any potential benefit of mirtazapine on disease outcomes. Further interventional studies are needed to confirm that 5-HT2AR inhibition is relevant to treat PML.
authors.affiliation: Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France. yvanjamilloux@hotmail.com.
authors.forename: Yvan
authors.identifier: http://orcid.org/0000-0001-5249-3650
authors.initials: Y
authors.lastname: Jamilloux
authors.affiliation: Department of Anaesthesiology and Critical Care, Lariboisière University Hospital, AP-HP, Paris, France.|ECSTRA Team, CRESS, Epidemiology and Statistics Centre, Sorbonne Paris Cité, UMR 1153, INSERM, Paris, France.|University Denis Diderot-Paris VII, Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Kerever
authors.affiliation: Department of Infectious Diseases, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, Lyon, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Ferry
authors.affiliation: Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.
authors.forename: Christiane
authors.initials: C
authors.lastname: Broussolle
authors.affiliation: Department of Neuro-oncology, Hopital Neurologique, Institut NeuroMyoGene (INMG) INSERM U1217/CNRS UMR 5310, Hospices Civils de Lyon, Université de Claude Bernard-Lyon 1, Bron, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Honnorat
authors.affiliation: Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Sève
mesh_terms: D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007577:JC Virus / Q000302:isolation & purification; D007968:Leukoencephalopathy, Progressive Multifocal / Q000188:drug therapy*; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000078785:Mirtazapine; D000069442:Natalizumab / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; D000069442:Natalizumab; D008803:Mianserin; D000078785:Mirtazapine