Progressive multifocal leukoencephalopathy medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
There is no known cure. In some cases, the disease slows or stops if the patient's [[immune system]] improves; some AIDS patients with PML have been able to survive for several years, with the advent of [[antiretroviral drug|highly active antiretroviral therapy]](HAART). | There is no known cure. In some cases, the disease slows or stops if the patient's [[immune system]] improves; some AIDS patients with PML have been able to survive for several years, with the advent of [[antiretroviral drug|highly active antiretroviral therapy]] (HAART). | ||
AIDS patients who start HAART after being diagnosed with PML tend to have a slightly longer survival time than patients who were already on HAART and then develop PML | AIDS patients who start HAART after being diagnosed with PML tend to have a slightly longer survival time than patients who were already on HAART and then develop PML.<ref>{{cite journal | author = Wyen C., Hoffmann C., Schmeisser N., Wohrmann A., Qurishi N., Rockstroh J., Esser S., Rieke A., Ross B. ''et al.'' | year = 2004 | title = Progressive multifocal leukencephalopathy in patients on highly active antiretroviral therapy: survival and risk factors of death | url = | journal = Journal of Acquired Immune Deficiency Syndrome | volume = 37 | issue = 2| pages = 1263–1268 | pmid = 15385733 }}</ref> A rare complication of effective HAART is [[immune reconstitution inflammatory syndrome]] (IRIS), in which increased immune system activity actually increases the damage caused by the infection; although IRIS is often manageable with other types of drugs, it is extremely dangerous if it occurs in PML.<ref>{{cite journal |author=Vendrely A, Bienvenu B, Gasnault J, Thiebault JB, Salmon D, Gray F |title=Fulminant inflammatory leukoencephalopathy associated with HAART-induced immune restoration in AIDS-related progressive multifocal leukoencephalopathy |journal=Acta Neuropathol. |volume=109 |issue=4 |pages=449–55 |year=2005 |month=April |pmid=15739098 |doi=10.1007/s00401-005-0983-y |url=}}</ref> | ||
Other antiviral agents that have been studied as possible treatments for PML include [[cidofovir]] and [[interleukin-2]], but this research is still preliminary. | Other antiviral agents that have been studied as possible treatments for PML include [[cidofovir]]<ref name="pmid11408993">{{cite journal |author=Segarra-Newnham M, Vodolo KM |title=Use of cidofovir in progressive multifocal leukoencephalopathy |journal=Ann Pharmacother |volume=35 |issue=6 |pages=741–4 |year=2001 |month=June |pmid=11408993 |doi= 10.1345/aph.10338|url=http://www.theannals.com/cgi/pmidlookup?view=long&pmid=11408993}}</ref> and [[interleukin-2]], but this research is still preliminary. | ||
Cytarabine (also known as ARA-C), a chemotherapy drug used to treat certain cancers, has been prescribed on an experimental basis for a small number of non-AIDS PML patients. It is reported to have stabilized the neurological condition of a minority of these patients.<ref>{{cite journal |author=Aksamit AJ |title=Treatment of non-AIDS progressive multifocal leukoencephalopathy with cytosine arabinoside |journal=J. Neurovirol. |volume=7 |issue=4 |pages=386–90 |year=2001 |month=August |pmid=11517422 |doi= 10.1080/13550280152537292|url=}}</ref> One patient regained some cognitive function lost as a result of PML.<ref>{{cite journal |author=Langer-Gould A, Atlas SW, Green AJ, Bollen AW, Pelletier D |title=Progressive multifocal leukoencephalopathy in a patient treated with natalizumab |journal=N. Engl. J. Med. |volume=353 |issue=4 |pages=375–81 |year=2005 |month=July |pmid=15947078 |doi=10.1056/NEJMoa051847 |url=}}</ref> | |||
In June 2010, the first case report appeared of a PML patient being successfully treated with [[mefloquine]]. Mefloquine is an antimalarial drug that can also act against the JC virus. Administration of mefloquine seemed to eliminate the virus from the patient's body and prevented further neurological deterioration.<ref>{{cite journal |author=Gofton TE, Al-Khotani1 A, O'Farrell B, Ang LC, McLachlan RS |title=Mefloquine in the treatment of progressive multifocal leukoencephalopathy |journal= J Neurol Neurosurg Psychiatry |volume= 82|issue= 4|pages= 452–455|year=2010 |month=June |pmid= 20562463|doi= 10.1136/jnnp.2009.190652|url=http://jnnp.bmj.com/content/early/2010/06/19/jnnp.2009.190652.full}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Mental disorders due to a general medical condition]] | [[Category:Mental disorders due to a general medical condition]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 18:48, 18 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
There is no known cure. In some cases, the disease slows or stops if the patient's immune system improves; some AIDS patients with PML have been able to survive for several years, with the advent of highly active antiretroviral therapy (HAART).
AIDS patients who start HAART after being diagnosed with PML tend to have a slightly longer survival time than patients who were already on HAART and then develop PML.[1] A rare complication of effective HAART is immune reconstitution inflammatory syndrome (IRIS), in which increased immune system activity actually increases the damage caused by the infection; although IRIS is often manageable with other types of drugs, it is extremely dangerous if it occurs in PML.[2]
Other antiviral agents that have been studied as possible treatments for PML include cidofovir[3] and interleukin-2, but this research is still preliminary.
Cytarabine (also known as ARA-C), a chemotherapy drug used to treat certain cancers, has been prescribed on an experimental basis for a small number of non-AIDS PML patients. It is reported to have stabilized the neurological condition of a minority of these patients.[4] One patient regained some cognitive function lost as a result of PML.[5]
In June 2010, the first case report appeared of a PML patient being successfully treated with mefloquine. Mefloquine is an antimalarial drug that can also act against the JC virus. Administration of mefloquine seemed to eliminate the virus from the patient's body and prevented further neurological deterioration.[6]
References
- ↑ Wyen C., Hoffmann C., Schmeisser N., Wohrmann A., Qurishi N., Rockstroh J., Esser S., Rieke A., Ross B.; et al. (2004). "Progressive multifocal leukencephalopathy in patients on highly active antiretroviral therapy: survival and risk factors of death". Journal of Acquired Immune Deficiency Syndrome. 37 (2): 1263–1268. PMID 15385733.
- ↑ Vendrely A, Bienvenu B, Gasnault J, Thiebault JB, Salmon D, Gray F (2005). "Fulminant inflammatory leukoencephalopathy associated with HAART-induced immune restoration in AIDS-related progressive multifocal leukoencephalopathy". Acta Neuropathol. 109 (4): 449–55. doi:10.1007/s00401-005-0983-y. PMID 15739098. Unknown parameter
|month=ignored (help) - ↑ Segarra-Newnham M, Vodolo KM (2001). "Use of cidofovir in progressive multifocal leukoencephalopathy". Ann Pharmacother. 35 (6): 741–4. doi:10.1345/aph.10338. PMID 11408993. Unknown parameter
|month=ignored (help) - ↑ Aksamit AJ (2001). "Treatment of non-AIDS progressive multifocal leukoencephalopathy with cytosine arabinoside". J. Neurovirol. 7 (4): 386–90. doi:10.1080/13550280152537292. PMID 11517422. Unknown parameter
|month=ignored (help) - ↑ Langer-Gould A, Atlas SW, Green AJ, Bollen AW, Pelletier D (2005). "Progressive multifocal leukoencephalopathy in a patient treated with natalizumab". N. Engl. J. Med. 353 (4): 375–81. doi:10.1056/NEJMoa051847. PMID 15947078. Unknown parameter
|month=ignored (help) - ↑ Gofton TE, Al-Khotani1 A, O'Farrell B, Ang LC, McLachlan RS (2010). "Mefloquine in the treatment of progressive multifocal leukoencephalopathy". J Neurol Neurosurg Psychiatry. 82 (4): 452–455. doi:10.1136/jnnp.2009.190652. PMID 20562463. Unknown parameter
|month=ignored (help)