Soroconversão do Vírus John Cunningham durante tratamento com natalizumabe
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Introdução: A esclerose múltipla é doença progressiva e difícil previsão, resultando em casos de incapacidade. O natalizumabe é terapia modificadora da doença altamente eficaz, porém associado a maior reativação do Vírus John Cunningham (JCV) e consequente aumento do risco de desenvolvimento de Leucoencefalopatia Multifocal Progressiva (LEMP). Objetivo: Analisar a soroconversão do JCV em pacientes tratados com natalizumabe. Métodos: Foi realizado estudo retrospectivo envolvendo pacientes com diagnóstico de esclerose múltipla, entre janeiro de 2012 a dezembro de 2021. Para avaliar soroconversão durante o tratamento com natalizumabe foram considerados os pacientes soronegativos ao início do tratamento e que tiveram no mínimo dois resultados no período de uso do medicamento. O trabalho foi aprovado no Comitê de Ética em Pesquisa em Seres Humanos sob protocolo 3.177.442. Resultados: Foram incluídos 62 pacientes tratados com natalizumabe, com soroprevalência de 67,7%. No início do tratamento 41,9% (26/62) dos pacientes eram negativos para anticorpos anti-JCV, desses, 23,1% (6/26) sofreram soroconversão. O tempo mediano de soroconversão foi de 2,5 anos. O índice basal de anticorpos anti-JCV apresentou correlação estatisticamente significativa com a idade dos pacientes. Dentre os pacientes com resultado negativo para anticorpo anti-JCV na linha de base, 82,6 % (19/23) permaneceram negativos durante todo o monitoramento. O tratamento foi descontinuado em 53,2% (33/62) dos pacientes, 72,7% (24/33) devido à positividade do anti-JCV com índice de anticorpos >1,5 em 41,9% dos casos. Conclusão: Conhecer o seguimento do índice de anticorpos anti-JCV e as condutas de tratamento em nossa coorte de pacientes pode ser útil nas decisões clínica futuras.
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