Clinical neuropharmacology
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Clin Neuropharmacol · Mar 2014
Benefit of additional screening for progressive multifocal leukoencephalopathy in patients with multiple sclerosis taking natalizumab: a decision analysis.
Patients with multiple sclerosis (MS) taking natalizumab are at risk for progressive multifocal leukoencephalopathy (PML). We sought to describe the outcomes of discontinuing natalizumab on the basis of PML risk and those of obtaining additional screening across a range of scenarios using decision tree models. ⋯ The highest PML risk identified by stratification is below 2.9%, suggesting that continuing natalizumab outweighs PML risk for most patients on the basis of theoretical calculations. However, decisions based on additional screening with high-specificity tests, including polymerase chain reaction cerebrospinal fluid tests for John Cunningham virus, may provide benefit and should be clinically tested. Increased precision of probabilities and quality-of-life values are also needed to improve decision making.