PML Risk Stratification in Multiple Sclerosis Patients on Natalizumab

Stratify risk of developing PML in patients with Multiple Sclerosis who are on natalizumab


Natalizumab is a monoclonal antibody that targets the a4 subunit of the a4b1 adhesion molecule with established clinical efficacy. It is infused monthly. The principal risk in use of natalizumab is that of development of Progressive Multifocal Encephalopathy (PML), a devastating brain parenchymal infection with no current treatment. Three main risk factors have been elucidated: JC virus antibody status, history of previous immunosuppression, and duration of natalizumab treatment (less than or greater than 2 years). If PML is suspected, the drug should be stopped.


Bloomgren G, Richman S, Hotermans C, Subramanyam M, Goelz S, Natarajan A, Lee S, Plavina T, Scanlon JV, Sandrock A, and Bozic C.

New England Journal of Medicine 2012 May 17, 366 (20): 1870-80

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1. Does the patient have positive JC virus antibody, using 2 step ELISA method?

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