Is it possible for me to develop PML?

Here is My Question:
Greetings. I have a question for you. In 2018, I tested positive for JCV and the index showed 0.38. Since then, the status has been negative. I started with Kesimpta therapy. I took Ocrevus for three years, now Kesimpta. My question is whether it is possible to develop PML. And how is it possible that the JCV status positive index 0.38 in 2018 was negative all this year. Thank you in advance for your answer.

Answer:
PML is uncommon in people with MS on anti-CD20 therapy (e.g., rituximab, ocrelizumab, ublituximab and ofatumumab). In fact, it is very uncommon on all MS therapies including natalizumab. There is no current way to stratify or assess the risk of PML in people on anti-CD20 therapy. The only exception is people with MS who recently stopped natalizumab and started an anti-CD20 therapy. They must first be assessed for evidence of asymptomatic PML before starting anti-CD20 therapy to prevent a carry-over case of PML. There is also reason to believe that significantly immunosuppressed individuals on anti-CD20 therapy may have an increased risk of PML.
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We use the JCV index to stratify risk of PML in people on Natalizumab (Tysabri) only; There is no data I am aware of that would allow us to use the JCV index to assess the risk of PML with other therapies.

People with low titer JCV index not uncommonly bounce back and forth between a negative result and a very low titer response with repeated testing. Most of the risk of PML in people on natalizumab occurs in people with high titers.


Revere P (Rip) Kinkel, MDProfessor of Neurosciences
Director of the Multiple Sclerosis Program
University of California San Diego
#PML #multiplesclerosis #JCV