Therapy with natalizumab is associated with high JCV seroconversion and rising JCV index values

Objective: The aim of the study was to analyze John Cunningham virus (JCV) serology in natalizumab-treated patients over time and assess whether they are influenced by natalizumab treatment. Methods: German (n = 1,921; 525 longitudinally) and French (n = 1,259; 711 longitudinally) patients were assessed for JCV serology alongside their therapy with natalizumab. Results: JCV serostatus changed in 69 of 525 longitudinally followed German patients (13.1%) over 14.8 months. Seroconversion according to serostatus was seen in 43 of 339 initially JCV-2 German patients (12.7% in 14.8 months; 10.3% per year) and 41 of 243 initially JCV2 - French patients (16.9% in 24 months; 8.5% per year). JCV index values could be reproduced (R-2 = 0.89) with the caveat of 8 of 50 samples (16%) being set into different risk categories between 2 assessments. Index values of JCV+ patients rose over time (p = 0.009) but not because of aging. Treatment with natalizumab was associated with a 15.9% increase of value in JCV+ patients in 14.8 months (12.9% per year). Conclusions: JCV seroconversion and index values may be influenced by treatment with natalizumab. It is therefore important to monitor patients' JCV serology but also to incorporate additional risk factors into the progressive multifocal leukoencephalopathy risk stratification. Neurol Neuroimmunol Neuroinflamm 2016;3:e195; doi: 10.1212/NXI.0000000000000195