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Treatment of Progressive Multifocal Leukoencephalopathy With Mirtazapine

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Abstract

Background and Objectives

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.

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Authors and Affiliations

  1. 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

    Yvan Jamilloux, Christiane Broussolle & Pascal Sève

  2. Department of Anaesthesiology and Critical Care, Lariboisière University Hospital, AP-HP, Paris, France

    Sébastien Kerever

  3. ECSTRA Team, CRESS, Epidemiology and Statistics Centre, Sorbonne Paris Cité, UMR 1153, INSERM, Paris, France

    Sébastien Kerever

  4. University Denis Diderot-Paris VII, Paris, France

    Sébastien Kerever

  5. Department of Infectious Diseases, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, Lyon, France

    Tristan Ferry

  6. 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

    Jérôme Honnorat

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  1. Yvan Jamilloux
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Corresponding author

Correspondence to Yvan Jamilloux.

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Conflict of interest

Yvan Jamilloux, Sébastien Kerever, Tristan Ferry, Christiane Broussolle, Jérôme Honnorat and Pascal Sève have no conflict of interest.

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Jamilloux, Y., Kerever, S., Ferry, T. et al. Treatment of Progressive Multifocal Leukoencephalopathy With Mirtazapine. Clin Drug Investig 36, 783–789 (2016). https://doi.org/10.1007/s40261-016-0433-8

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  • DOI: https://doi.org/10.1007/s40261-016-0433-8

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