Therapy with natalizumab is associated with high JCV seroconversion and rising JCV index values

Nicholas Schwab; Tilman Schneider-Hohendorf; Béatrice Pignolet; Johanna Breuer; Catharina C Gross; Kerstin Göbel; David Brassat; Heinz Wiendl

doi:10.1212/NXI.0000000000000195

Therapy with natalizumab is associated with high JCV seroconversion and rising JCV index values

Neurol Neuroimmunol Neuroinflamm. 2016 Jan 27;3(1):e195. doi: 10.1212/NXI.0000000000000195. eCollection 2016 Feb.

Authors

Nicholas Schwab¹, Tilman Schneider-Hohendorf¹, Béatrice Pignolet¹, Johanna Breuer¹, Catharina C Gross¹, Kerstin Göbel¹, David Brassat¹, Heinz Wiendl¹

Affiliation

¹ Department of Neurology (N.S., T.S.-H., J.B., C.C.G., K.G., H.W.), University of Münster, Germany; and Pole des Neurosciences Centre Hospitalier Universitaire Toulouse (B.P., D.B.), CPTP INSERM UMR 1043 et Université de Toulouse, UPS, Toulouse, France. D.B. also represents the BioNAT Study Group.

Abstract

Objective: The aim of the study was to analyze John Cunningham virus (JCV) serology in natalizumab-treated patients over time and assess whether they are influenced by natalizumab treatment.

Methods: German (n = 1,921; 525 longitudinally) and French (n = 1,259; 711 longitudinally) patients were assessed for JCV serology alongside their therapy with natalizumab.

Results: JCV serostatus changed in 69 of 525 longitudinally followed German patients (13.1%) over 14.8 months. Seroconversion according to serostatus was seen in 43 of 339 initially JCV- German patients (12.7% in 14.8 months; 10.3% per year) and 41 of 243 initially JCV- French patients (16.9% in 24 months; 8.5% per year). JCV index values could be reproduced (R (2) = 0.89) with the caveat of 8 of 50 samples (16%) being set into different risk categories between 2 assessments. Index values of JCV+ patients rose over time (p = 0.009) but not because of aging. Treatment with natalizumab was associated with a 15.9% increase of value in JCV+ patients in 14.8 months (12.9% per year).

Conclusions: JCV seroconversion and index values may be influenced by treatment with natalizumab. It is therefore important to monitor patients' JCV serology but also to incorporate additional risk factors into the progressive multifocal leukoencephalopathy risk stratification.