Highlights
- •The beneficial use of maraviroc in PML is still anecdotal.
- •Three Italian PML cases treated with maraviroc are described.
- •Data are interpreted in light of the Italian national database.
- •Data do not support the beneficial use of maraviroc in PML and PML-IRIS.
- •Clinical stabilization of patients with PML-IRIS was evident only after steroids use.
Abstract
Background
Despite the recent advances in the understanding of natalizumab (NTZ) related progressive
multifocal leukoencephalopathy (PML) and its associated immune reconstitution inflammatory
syndrome (PML-IRIS), the therapeutic options are still under investigated. In this
context, the beneficial use of maraviroc is still an anecdotal observation.
Objective
To evaluate the impact of maraviroc in modifying the course of PML preventing IRIS
or blunting IRIS manifestations.
Methods
Three patients with NTZ PML included in the Italian dataset of PML were treated with
maraviroc. Their longitudinal clinical and radiological course was described in detail.
Results
The three patients were characterized by a steady clinical worsening not controlled
by maraviroc. All the three patients manifested PML-IRIS, which emerged, respectively,
at 62, 64 and 90 days post NTZ withdrawal. This is in accordance with the data of the Italian dataset.
Clinical and radiological stabilization of PML-IRIS occurred only after corticosteroids
administration.
Conclusion
In these three cases, maraviroc did not show any clear effect in modulating the clinical
course of PML preventing IRIS. Moreover, once PML-IRIS emerged, the clinical stabilization
was achieved only with the use of corticosteroids. Thus, the use of maraviroc should
be regarded with extreme caution due the potential adverse events associated with
its use.
Keywords
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Article info
Publication history
Published online: May 12, 2017
Accepted:
May 10,
2017
Received in revised form:
April 21,
2017
Received:
March 14,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
