Serological profile of John Cunningham virus (JCV) in patients with multiple sclerosis.
Branco LP, Adoni T, Apostolos-Pereira SL, Brooks JBB, Correa EC, Damasceno CA, Eboni ACB, Fezer L, Gama PDD, Goncalves MVM, Gomes S, Grzesiuk AK, Mendes MF, Morales RR, Muniz A, Parolin MFK, Pimentel MLV, Ribeiro MC, Santos GACD, Sato HK, Scherpenhuijzen SB, Scorcine C, Siquineli F, Sousa NAC, Varela DL, Winckler TCA, Fragoso YD.Abstract
Treatment options for multiple sclerosis (MS) have changed over the last few years, bringing about a new category of drugs with more efficient profiles. However, these drugs have come with a whole new profile of potential adverse events that neurologists have to learn well and quickly. One of the most feared complications of these MS treatments is progressive multifocal leukoencephalopathy caused by the reactivation of the John Cunningham virus (JCV).
OBJECTIVE:
To identify the serologic profile of JCV in patients with MS.
METHODS:
Data on serum antibodies for JCV were obtained using the enzyme-linked immunosorbent assay provided by the STRATIFY-JCV program.
RESULTS:
A total of 1,501 blood tests were obtained from 1,102 patients with MS. There were 633 patients (57.1%) who were positive for antibodies for JCV and 469 patients who were negative (42.9%). Twenty-three patients became positive after initially having negative JCV antibody status. The rate of seroconversion was 18.5% over 22 months.
CONCLUSION:
The JCV serologic profile and seroconversion in Brazilian patients were similar to those described in other countries.
In healthcare decision making it is not unusual to stumble across fear. The worry over whether you are making the correct decision assumes that you would be rewarded in some way for that decision, and the opposite if you were wrong. More over, there is a certain caveat emptor (the buyer beware) when in comes to these decision making processes; the buyer in this case you, has less information about the good or service that they are purchasing than the seller, in this case the healthcare professional, who has more information.
The only problem is that the universe has no fixed agenda, and once you make that decision it simply works around it, at times impervious to the outcome. So how do we overcome this uncertainty?
Infection with JCV is one such massive problem in multiple sclerosis. Not surprisingly then, most countries have reported on their local prevalence of the virus. The Brazilian JCV status, as published in this study involving 633 PwMS is in line with that reported by other countries. The worldwide prevalence of JCV in MS taking into account data from 26 countries is 57.1% (so there is more than a 50:50% chance that if you have your blood tested today that you'd be positive) and the range of positive antibodies to JCV is also 40-69%. The rate of conversion from negative to positive JCV is roughly 11% per year from a further two large studies, although low conversion rates, such as 6% have been reported from a study in Portugal after 5years. In this Brazilian study, the rate of seroconversion was 19% over 22 months - again comparable.
As a majority of these worldwide epidemiological studies have now reported similar findings, it is important that we strategize on finding solutions to this problem, since we all know that immunosuppressants are here to stay in so far as MS treatments are concerned. The solution has to be simple to keep the probable outcomes manageable. In this case, restrict exposure to therapies linked to PML (JCV infection), work out the correct sequencing approach if you're more comfortable using escalation approaches, or stick to induction treatments and check JCV status at specified time points, in order to evaluate future risk.