Mirtazapine Use in Human Immunodeficiency Virus–Infected Patients With Progressive Multifocal Leukoencephalopathy

Cettomai, Deanna; McArthur, Justin C.

doi:10.1001/archneurol.2008.557

Cited by 107 publications

(76 citation statements)

References 13 publications

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“…Mirtazapine, an antidepressant that acts inhibiting this receptor has been used in treatment of PML. Although the concept sounds attractive and the drug is usually well tolerated, the evidence to date is scarce and based mostly in case reports and small series 24 . The benefit is modest at best, but it can be considered both in patients with and without HIV infection.…”

Section: Treatmentmentioning

confidence: 99%

Progressive multifocal leukoencephalopathy: new concepts

Lima

2013

Arq. Neuro-Psiquiatr.

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Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the CNS caused by reactivation of JC virus (JCV). Primary infection occurs in childhood and it is asymptomatic in most patients. Thereafter, the virus remains latent in the kidney, bone marrow and lymphoid organs, but, in a setting of cellular immunosuppression, the virus reactivates, spreads to the central nervous system (CNS), leading to infection of oligodendrocytes and demyelination 1 . Most often, PML presents with motor deficits, visual disturbances and cognitive impairment, in a subacute evolution. On MRI, lesions are hyperintense on T2-weighted and Fluid attenuated inversion recovery (FLAIR) sequences and located predominantely in the subcortical white matter of the cerebral hemispheres and cerebellar peduncles 2 . Originally, PML was observed in patients with advanced HIV infection, lymphoproliferative disorders and transplant recipients. However, the widespread use of HIV antiretroviral drugs and new selective immunomodulatory and immunosuppressive medications, such as Rituximab and Natalizumab, had recently modified the epidemiology, clinical presentation and prognosis of PML 3 . Herein, we discuss the new concepts on PML, emphasizing the recent modification in the epidemiology, the impact of new immunomodulatory treatments in the disease, PML-IRIS, new treatment strategies and other JCV related CNS diseases. EpidemiologyFrom the 1958 to 1980`s, PML was observed mostly in patients being treated with corticosteroids and other immunosuppressive drugs, as well as individuals with hematological malignancies. A review of the literature in 1984 revealed only 230 cases, most of them associated with hematological diseases 4 . The emergence of AIDS changed the PML ABStrACt Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the CNS caused by reactivation of JC virus (JCV) in a setting of cellular immunosuppression. Originally, PML was observed in patients with advanced HIV infection, lymphoproliferative disorders and transplant recipients. However, the widespread use of HIV antiretroviral drugs and the new selective immunomodulatory and immunosuppressive medications, such as Rituximab and Natalizumab, has recently modified the epidemiology, clinical presentation and prognosis of PML. Herein, we discuss the new concepts on PML, emphasizing the recent modification in the epidemiology; the impact of new immunomodulatory treatments in the disease, PML-IRIS (Immune reconstitution inflammatory síndrome), new treatment strategies and other JCV related CNS diseases.Keywords: leukoencephalopathy, natalizumab, JC virus. rESUMO A leucoencefalopatia multifocal progressiva (LMP) é uma doença desmielinizante do sistema nervoso central (SNC) causada pela reativação do vírus JC (JCV) em um ambiente de imunossupressão celular. Originalmente, LMP foi descrita em pacientes com infecção avançada pelo HIV, doenças linfoproliferativas e transplantados. No entanto, a utilização generalizada de anti-retrovirais para a infecç...

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Section: Treatmentmentioning

confidence: 99%

Progressive multifocal leukoencephalopathy: new concepts

Lima

2013

Arq. Neuro-Psiquiatr.

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“…Serotonin receptor 2A (5-HT2AR) seems to be involved in JCV internalization into glial cells and some serotonin receptor antagonists (i.e., risperidone, mirtazapine) have been proposed as agents potentially blocking JCV entry [7,8]. Two of the present cases received mirtazapine and/or risperidone as a tentative salvage therapy, but these drugs did not provide appreciable benefits.…”

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confidence: 78%

Progressive multifocal leukoencephalopathy: a report of three cases in HIV-negative patients with non-Hodgkin's lymphomas treated with rituximab

et al. 2009

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“…In the recent years 5-HT2 a inhibitors/ serotonin receptor antagonists have been proposed for PML treatment [21]. Experimental case studies for some agents such as risperidone and mirtazapine, serotonergic receptor blockers are being tried [22,23]. The best treatment option at present is focused on antiretroviral agents like Zidovudine, Emtricitabine, Abacavir, Nevirapine and Lopinavir.…”

Section: Discussionmentioning

confidence: 99%

Progressive Multifocal Leukoencephalopathy Associated with Pulmonary Tuberculosis in an Immuno-Compromised Indian Patient

Singh¹

2013

J AIDS Clin Res

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Mirtazapine Use in Human Immunodeficiency Virus–Infected Patients With Progressive Multifocal Leukoencephalopathy

Cited by 107 publications

References 13 publications

Progressive multifocal leukoencephalopathy: new concepts

Progressive multifocal leukoencephalopathy: new concepts

Progressive multifocal leukoencephalopathy: a report of three cases in HIV-negative patients with non-Hodgkin's lymphomas treated with rituximab

Progressive Multifocal Leukoencephalopathy Associated with Pulmonary Tuberculosis in an Immuno-Compromised Indian Patient

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