{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:39:00Z","timestamp":1789609140086,"version":"build-2803163510"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,10,31]],"date-time":"2017-10-31T00:00:00Z","timestamp":1509408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To retrospectively analyze the effect of plasma exchange (PLEX; yes = PLEX<jats:sup>+<\/jats:sup>, no = PLEX<jats:sup>\u2013<\/jats:sup>) and steroids administration timing (prophylactically [proST] or therapeutically [therST]) on the longitudinal clinical course of patients with natalizumab\u2010related progressive multifocal leukoencephalopathy (PML) and full\u2010blown immune reconstitution inflammatory syndrome (PML\u2010IRIS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical and radiological data of 42 Italian patients with PML were analyzed. Patient's data are available until 12 months after PML diagnosis. PLEX and steroids treatment as time\u2010dependent covariates were entered in: (1) a Cox model to investigate their impact on full\u2010blown PML\u2010IRIS latency; (2) an analysis of variance ANOVA to investigate their impact on IRIS duration; and (3) a linear mixed model to assess their impact on the longitudinal clinical course (measured by means of Expanded Disability Status Scale [EDSS]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Treatment with PLEX was not associated to PML\u2010IRIS latency (hazard ratio [HR] = 1.05; <jats:italic>p<\/jats:italic> = 0.92), but once IRIS emerged, its duration was significantly longer in patients who underwent PLEX (101 vs 54 days in PLEX<jats:sup>+<\/jats:sup> and PLEX<jats:sup>\u2013<\/jats:sup> patients; <jats:italic>p<\/jats:italic> = 0.028). Receiving proST versus therST was not associated to IRIS latency (HR = 0.67; <jats:italic>p<\/jats:italic> = 0.39) or duration (<jats:italic>p<\/jats:italic> = 0.95). Patients who underwent proST had a significantly higher EDSS increase during PML (0.09 EDSS points per month; <jats:italic>p<\/jats:italic> = 0.04) as compared to those who had therST.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>This study highlights that: (1) caution on the use of PLEX should be considered as the current data do not support a beneficial effect of PLEX and (2) caution on the early use of steroids is suggested because their prophylactic use to prevent full\u2010blown PML\u2010IRIS seems to negatively impact on the longitudinal disability course. 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