{"id":"3eccde83-3791-48f9-98a1-b7203534d36f","slug":"anti-john-cunningham-virus-antibody-index-levels-in-multiple-sclerosis-patients-treated-with-rituximab-fingolimod-and-dimethyl-fumarate","title":"Anti-John Cunningham virus antibody index levels in multiple sclerosis patients treated with rituximab, fingolimod, and dimethyl fumarate","authors":["Stephen Farley","Malcolm H. Gottesman","Sharon Friedman-Urevich","Janin Ye","Mark Shen","Denise Grueneberg","Lorraine Martone","Rose Calixte"],"abstract":"Background: Progressive multifocal leukoencephalopathy (PML), a potentially fatal demyelinating disease caused by the John Cunningham virus (JCV), can occur as a complication of treatment with rituximab, fingolimod, and dimethyl fumarate. The primary objective of this study was to determine changes in anti-JCV antibody index values in multiple sclerosis (MS) patients treated with these three medications. Second, we explored the relationship between absolute lymphocyte count (ALC), anti-JCV antibody index values, and various patient characteristics. Methods: In this retrospective chart review, we evaluated changes in JCV serology and ALC in 172 MS patients treated with fingolimod, rituximab, or dimethyl fumarate (2013–2016). Only those with known anti-JCV antibody and ALC values before starting the study medications were included. Subsequent values were obtained on an ad hoc basis throughout the study. Results: There was a significant decrease in anti-JCV antibody index values in patients treated with fingolimod and rituximab (P = 0.03 and P = 0.014, respectively). A non-significant decreasing trend in anti-JCV antibody index values occurred in patients treated with dimethyl fumarate. Notably, there was no relationship between ALC and anti-JCV antibody index values for patients treated with rituximab, fingolimod, or dimethyl fumarate. Conclusions: Anti-JCV antibody index values significantly decreased in MS patients treated with fingolimod and rituximab; however, this did not occur with dimethyl fumarate. Fingolimod and rituximab may impair the humoral response to the JCV. Nevertheless, a declining anti-JCV antibody index in MS patients treated with fingolimod or rituximab should not necessarily be interpreted as correlating with a decreased risk for PML.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/3eccde83-3791-48f9-98a1-b7203534d36f/featured/hero-1782420864164.png","publishDate":"2019-04-24T00:00:00.000Z","doi":"10.25259/SNI-4-2019","categories":["General Neurosurgery","Original Article"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2019/04/9295/SNI-10-59.pdf"}