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The impact of lymphocytosis and CD4/CD8 ratio on the anti-JCV antibody index and clinical data in patients treated with natalizumab

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Abstract

Background

Natalizumab is an effective therapy in the treatment of relapsing-remitting multiple sclerosis; it induces lymphocytosis (NIL, natalizumab-induced lymphocytosis) and changes the peripheral lymphocyte pattern.

Methods

This study aims to evaluate NIL, peripheral blood lymphocyte subsets, CD4/CD8 ratio, and their impacts on JCV index and clinical data—No Evidence of Disease Activity (NEDA-3) and annualized relapse rate (ARR) in patients treated with natalizumab.

Results

Forty-one patients (33 women) were included in the study. The mean duration of follow-up on natalizumab treatment was 6.7 ± 3.2 years. Significant increases in relative lymphocytosis after 1 month, with a median of 40.4% (− 34.1 to + 145.5%) (p < 0.001), and after 1 year (49.0% (− 9.3 to + 127.6%)) (p < 0.001) were found. Significant differences were found after 1 month when comparing NIL between patients JCV-seroconverting (20.6% (− 17.7 to 72.7%)) and stable JCV-seronegative ones (43.5% (− 6.3 to +96.3%)) (p = 0.04). No significant difference NIL level was found between the patients exhibiting NEDA-3 status and those without it. ARR on natalizumab treatment correlated with CD4/CD8 ratio (r = 0.356; p = 0.021); patients who maintained NEDA-3 status over the whole treatment period exhibited a lower CD4/CD8 ratio (1.89 ± 1.08 vs. 2.5 ± 0.73; p < 0.04).

Conclusion

This contribution reports the CD4/CD8 ratio as a possible biomarker for better clinical efficacy of natalizumab in patients exhibiting a lower CD4/CD8 ratio. NIL did not correlate with long-term therapeutic efficacy in patients treated with natalizumab, but was demonstrated as lower in patients JCV-seroconverting in the course of follow-up.

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Acknowledgments

Tony Long (Dalmellington) helped work up the English.

Funding

This work was supported by the Ministry of Health of the Czech Republic, ref. - RVO (FNBr, 65269705), and the project of specific research ref. MUNI/A/1325/2019 from the program of support of student projects at Masaryk University.

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Authors and Affiliations

  1. Faculty of Medicine, Masaryk University, Brno, Czech Republic

    Jan Kolcava, Monika Hulova, Josef Bednarik & Pavel Stourac

  2. Department of Neurology, University Hospital Brno, Jihlavská 340/20, 625 00, Brno, Czech Republic

    Jan Kolcava, Monika Hulova, Josef Bednarik & Pavel Stourac

  3. Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic

    Lucie Rihova

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  1. Jan Kolcava
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Correspondence to Pavel Stourac.

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Kolcava, J., Hulova, M., Rihova, L. et al. The impact of lymphocytosis and CD4/CD8 ratio on the anti-JCV antibody index and clinical data in patients treated with natalizumab. Neurol Sci 42, 2847–2853 (2021). https://doi.org/10.1007/s10072-020-04897-2

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