Clinical Drug Investigation

, Volume 36, Issue 10, pp 783–789 | Cite as

Treatment of Progressive Multifocal Leukoencephalopathy With Mirtazapine

  • Yvan Jamilloux
  • Sébastien Kerever
  • Tristan Ferry
  • Christiane Broussolle
  • Jérôme Honnorat
  • Pascal Sève
Systematic Review


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.


We analysed existing data on mirtazapine’s efficacy to treat PML by systematically reviewing the literature since 2005, when it was first used.


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.


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.


Human Immunodeficiency Virus Progressive Multifocal Leukoencephalopathy Mirtazapine Fingolimod Cidofovir 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards


No source of funding.

Conflict of interest

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

Supplementary material

40261_2016_433_MOESM1_ESM.pdf (322 kb)
Supplementary material 1 (PDF 321 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de LyonUniversité Claude Bernard-Lyon 1LyonFrance
  2. 2.Department of Anaesthesiology and Critical CareLariboisière University Hospital, AP-HPParisFrance
  3. 3.ECSTRA Team, CRESS, Epidemiology and Statistics Centre, Sorbonne Paris CitéUMR 1153, INSERMParisFrance
  4. 4.University Denis Diderot-Paris VIIParisFrance
  5. 5.Department of Infectious Diseases, Hopital de la Croix-Rousse, Hospices Civils de LyonUniversité Claude Bernard-Lyon 1LyonFrance
  6. 6.Department of Neuro-oncology, Hopital Neurologique, Institut NeuroMyoGene (INMG) INSERM U1217/CNRS UMR 5310, Hospices Civils de LyonUniversité de Claude Bernard-Lyon 1BronFrance

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