Der Nervenarzt

, 80:1143

Progressive multifokale Leukenzephalopathie

Unerwünschte Nebenwirkung einer Immuntherapie
  • H.-P. Hartung
  • C. Warnke
  • R. Hohlfeld
  • B.C. Kieseier
Übersichten

Zusammenfassung

Die kürzlich publizierten Fälle von progressiver multifokaler Leukenzephalopathie (PML) bei Patienten mit schubförmiger Multipler Sklerose (MS) unter Behandlung mit dem monoklonalen Antikörper Natalizumab erfordern die erneute Auseinandersetzung mit den Vorteilen und Risiken einer äußerst wirksamen Immuntherapie. Auf Grundlage bisheriger Konzepte zur Pathogenese der PML unter Natalizumab-Therapie soll in dieser Übersichtsarbeit die Frage adressiert werden, welche praktischen Konsequenzen aus den neuen PML-Fällen für die Therapie der MS mit Natalizumab zu ziehen sind. Diskutiert werden dabei die kritische Selektion der Patienten auf Basis einer Risiko-Nutzen-Abwägung, zeitlich limitierte Therapieregime, die frühzeitige Diagnosestellung der PML auf Grundlage klinischer, MR-tomographischer und erregerdiagnostischer Kriterien sowie auch erste therapeutische Ansätze zur Behandlung der PML. Ärztliches Ziel muss es letztlich sein, die Risiken mit allen zur Verfügung stehenden Mitteln zu minimieren, um einen individuell optimalen Therapieerfolg zu erzielen.

Schlüsselwörter

Natalizumab Multiple Sklerose Progressive multifokale Leukenzephalopathie Alpha4-beta1-Integrin 

Progressive multifocal leukoencephalopathy

Undesirable side effect of immunotherapy

Summary

As new cases arise of progressive multifocal leukoencephalopathy (PML) in patients with multiple sclerosis (MS) treated with the monoclonal antibody natalizumab, a critical discussion about risks and advantages of this specific kind of immunotherapy appears necessary. Practical consequences and treatment options are addressed based on current concepts of PML’s pathogenesis in patients treated with natalizumab. Critical patient selection based on risk:benefit considerations, limited therapy regimens, early diagnosis of PML by clinical and paraclinical criteria, and therapeutic perspectives for treating PML are discussed. The risk of PML in patients with MS needs to be continually monitored and should be reduced with all means available to ensure optimal outcome.

Keywords

Natalizumab Multiple sclerosis Progressive multifocal leukoencephalopathy Alpha4 beta1 integrin 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  • H.-P. Hartung
    • 1
  • C. Warnke
    • 1
  • R. Hohlfeld
    • 2
  • B.C. Kieseier
    • 1
  1. 1.Neurologische KlinikHeinrich-Heine-UniversitätDüsseldorfDeutschland
  2. 2.Institut für Klinische Neuroimmunologie, Klinikum GroßhadernLudwig-Maximilians-UniversitätMünchenDeutschland

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