Abstract
BACKGROUND: A rare complication of natalizumab treatment is progressive multifocal leukoencephalopathy (PML); risk can be stratified using JC virus (JCV) antibody status. Risk calculators to aid clinical decision-making use cohort data tested using the Stratify-JCV assay. Following concerns of an increased number of JCV seropositive results following the switch to biosimilar natalizumab and the associated test switch, we sought to understand the clinical implications. METHODS: A total of 497 people with MS, who had switched from Tysabri to Tyruko with sequential results available on both assays, were included. RESULTS: Of 250 patients negative on Stratify-JCV, 119 (47.6%) were subsequently positive on ImmunoWELL. Agreement was the poorest at lower JCV index, where positive/negative cutoffs inform risk stratification and pharmacovigilance protocols most significantly. CONCLUSION: These observed differences create uncertainty in how to counsel patients and best carry out PML surveillance. Specific concerns include overestimating risk leading to increased patient concern, increased monitoring burden and associated healthcare costs and lack of access to a highly effective therapy. It is incumbent on all stakeholders including pharmaceutical industry and test developers, patient groups, governmental authorities (including regulatory bodies) and clinicians to work together to find an expeditious solution.