{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:05:04Z","timestamp":1777878304617,"version":"3.51.4"},"reference-count":31,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2013,12,13]],"date-time":"2013-12-13T00:00:00Z","timestamp":1386892800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Chronic Disease"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:p>Natalizumab (NTZ) is a highly effective disease modifying therapy for the treatment of relapsing forms of multiple sclerosis (MS). Despite evidence to support its use as first-line therapy, risk of NTZ-associated progressive multifocal leukoencephalopathy (PML) has largely contributed to it being relegated to a second-line position. Recent preliminary data may allow for a more accurate analysis of JC virus (JCV) risk stratification of a given patient\u2019s PML risk. Herein we propose an algorithm to help guide clinicians through this decision-making process. We recommend that NTZ be considered for first-line use in JCV antibody negative MS patients, JCV \u2018low positive\u2019 MS patients without prior exposure to immunosuppression and for a limited period (12\u201324 months) in JCV \u2018high positive\u2019 MS patients with an aggressive disease course . We caution against first-line use in JCV antibody \u2018high positive\u2019 patients beyond 12\u201324 months and any JCV antibody positive patient with a history of prior immunosuppression.<\/jats:p>","DOI":"10.1177\/2040622313514790","type":"journal-article","created":{"date-parts":[[2013,12,13]],"date-time":"2013-12-13T22:18:36Z","timestamp":1386973116000},"page":"62-68","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["First-line natalizumab in multiple sclerosis: rationale, patient selection, benefits and risks"],"prefix":"10.1177","volume":"5","author":[{"given":"Jacqueline Ann","family":"Nicholas","sequence":"first","affiliation":[{"name":"The Ohio State University Multiple Sclerosis Center, 395 W 12th Avenue, 7th Floor, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael Karl","family":"Racke","sequence":"additional","affiliation":[{"name":"Department of Neurology and Multiple Sclerosis Center, The Ohio State University, Columbus, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Imitola","sequence":"additional","affiliation":[{"name":"Department of Neurology and Multiple Sclerosis Center, The Ohio State University, Columbus, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron Lee","family":"Boster","sequence":"additional","affiliation":[{"name":"Department of Neurology and Multiple Sclerosis Center, The Ohio State University, Columbus, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,12,13]]},"reference":[{"key":"bibr1-2040622313514790","first-page":"495","volume":"12","author":"Berger J.","year":"2011","journal-title":"Discovery Med"},{"key":"bibr2-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1002\/ana.23893"},{"key":"bibr3-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe058122"},{"key":"bibr4-2040622313514790","unstructured":"Biogen Idec (2013) PML incidence in patients receiving Tysabri\u00ae (natalizumab). Available at: https:\/\/medinfo.biogenidec.com"},{"key":"bibr5-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107829"},{"key":"bibr6-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2011.03577.x"},{"key":"bibr7-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70028-4"},{"key":"bibr8-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.62.11.1681"},{"key":"bibr9-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000145762.60562.5D"},{"key":"bibr10-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2008.541"},{"key":"bibr11-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2011.45"},{"key":"bibr12-2040622313514790","volume-title":"65th Annual Meeting of the American Academy of Neurology","author":"Dong-Si T.","year":"2013"},{"key":"bibr13-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22128"},{"key":"bibr14-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70021-3"},{"key":"bibr15-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-009-0093-1"},{"issue":"1","key":"bibr16-2040622313514790","first-page":"P04.134","volume":"78","author":"Kappos L.","year":"2012","journal-title":"Neurology"},{"key":"bibr17-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1097\/01.PHM.0000078199.99484.E2"},{"key":"bibr18-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa051782"},{"key":"bibr19-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa051847"},{"key":"bibr20-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1111\/j.1750-3639.2007.00064.x"},{"key":"bibr21-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-011-6019-8"},{"key":"bibr22-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.63.10.1366"},{"key":"bibr23-2040622313514790","volume-title":"27th Annual Meeting of the Consortium of Multiple Sclerosis Centers","author":"Plavina T.","year":"2013"},{"key":"bibr24-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044397"},{"key":"bibr25-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000158329.30470.D0"},{"key":"bibr26-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044396"},{"key":"bibr27-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2012.04.022"},{"key":"bibr28-2040622313514790","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200519110-00002"},{"key":"bibr29-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1038\/nrd1752"},{"key":"bibr30-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20858"},{"key":"bibr31-2040622313514790","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa051586"}],"container-title":["Therapeutic Advances in Chronic Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2040622313514790","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2040622313514790","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2040622313514790","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:17:05Z","timestamp":1777591025000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2040622313514790"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,12,13]]},"references-count":31,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2014,3]]}},"alternative-id":["10.1177\/2040622313514790"],"URL":"https:\/\/doi.org\/10.1177\/2040622313514790","relation":{},"ISSN":["2040-6223","2040-6231"],"issn-type":[{"value":"2040-6223","type":"print"},{"value":"2040-6231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,12,13]]}}}