2022 年 39 巻 3 号 p. 292-295
Neuroimmunological disorders have been treated with not only oral corticosteroids and immunosuppressants, but also various biological products in recent years. Especially in multiple sclerosis (MS), natalizumab, fingolimod, dimethyl fumarate, ofatumumab, etc. have appeared as disease modifying drugs (DMDs), and treatment options are available and spreading.
On the other hand, there is progressive multifocal leukoencephalopathy (PML) as a representative of the neurological diseases that newly occur with the treatment of DMDs. It is one of the central nervous system infections caused by JC virus (JCV), and is a rare disease that causes multifocal demyelinating lesions in the brain triggered by a decrease in cell–mediated immunity of the host. In recent years, various neuroimmune diseases have been treated with DMDs, and many reports of drug–related PML have been recognized. Regarding PML associated with DMDs in MS, which is the most common underlying disease of drug–related PML, the risks and precautions in daily medical care are summarized.
There are characteristics of each drug, and factors of risk factors of PML are being investigated, but some drugs have unclear risk factors. Recommends regular MRI for early detection, peripheral blood lymphocyte count monitoring for stratification in daily medical care.
