Could there be a new drug on the horizon to combat PML? A new study released in the New England Journal of Medicine on January 30, 2014 indicates there may be just that.
When one is diagnosed with PML they typically go through plasmapheresis in an effort to remove harmful antibodies and to ride the body of the JC Virus. This process can actually cause another serious illness called IRIS. IRIS is responsible for many deaths and severe disabilities. Untreated PML is often fatal leaving patients with few options.
In a recently study a JC Virus positive MS patient was given the plasmapheresis PML treatment and then immediately began 300 mg twice daily of the antiretroviral drug, Maraviroc, for two months. She stopped the medication for five (5) days resulting in cognitive & behavioral symptoms and MRI changes indicating IRIS. Continuing on Maraviroc the patient improved but suffered mild permanent brain damage from IRIS. Once the MRI showed IRIS regression Maraviroc was reduced to 150 mg twice daily and tapered off at seven months when the MRI showed no progression of IRIS and the patient became JC Virus negative once again. The significance of this study of Maraviroc is that IRIS was prevented initially and then treated successfully after its on-set.
Progressive multifocal leukoencephalopathy, or PML, is an infection causing brain inflammation as a result of the JC Virus. Patients taking some medications for autoimmune diseases can develop the JC Virus. PML can result in death or permanent neurocognitive deficits. The plasmapheresis PML treatment can actually cause another serious illness called immune reconstitution inflammatory syndrome, or IRIS. The reality is death and disabilities from PML is actually caused by IRIS.
More information can be found at: http://www.nejm.org/doi/full/10.1056/NEJMc1304828. Image from www.thebody.com.