Maillart et al - NEURIMMINFL/2016/009894

Figure e-1:

Legend of the figure e-1

Evolution of brain MRI of patient 1: two (M2), four (M4) and thirty-five (M35) months

after Progressive Multifocal Leukoencephalopathy (PML) diagnosis.

Modified from figure 1, from Maillart E, et al. Fingolimod to treat severe multiple scle-

rosis after natalizumab-associated progressive multifocal leukoencephalopathy: a valid

option? Multiple sclerosis 2014;20:505-509.

Fluid-attenuated inversion recovery (FLAIR) (a and e) and T1-weighted sequence with

gadolinium (b, c, d, f)

• IRIS : FLAIR (a) and T1 weighted-sequence with gadolinium (b): ontrast enhancement sur-

rounding PML lesions.

• multiple sclerosis activity: T1-weighted sequence with gadolinium (c, d)

• On fingolimod: FLAIR (e) and T1 weighted-sequence with gadolinium (f): no progression

of PML lesion, severe atrophy.

MS: multiple sclerosis; MRI: magnetic resonance imaging; PML: progressive multifocal

leukoencephalopathy; IRIS: immune reconstitution inflammatory syndrome

Maillart et al - NEURIMMINFL/2016/009894

Maillart et al - NEURIMMINFL/2016/009894

Table e-1: General characteristics of multiple sclerosis patients and natalizumab

related-progressive multifocal leukoencephalopathy, with median, Q1 and Q3.

General characteristics, M (SD)Whole cohort

N=23

Age at MS onset 30 [25-36]*

Female, % (N) 65.2 (15)

Age at PML onset 42.0 [36.5-46.5]*

Duration of MS before Nz onset (years) 11.25 [7.22-16.07]*

Number of MS therapy before Nz onset 2 [1-3]*

Nz Treatment

EDSS at Nz onset 4 .0 [3.0-5.5]*

EDSS after 1 year of Nz therapy 4.0 [2.5-5.75]*

Number of Nz infusions 43.0 [39.0-49.5]*

Duration of Nz therapy (years) 3.54 [3.09-3.85]*

Number of relapses during Nz therapy, % (N)

0 60.9 (14)

1 26.1 (6)

≥ 2 13.0 (3)

PML, % (N)

Symptoms, % (N)

Limb weakness 43.5 (10)

Cerebellar syndrome 30.4 (7)

Speech Disorders 17.4 (4)

Cognitive disorders 21.7 (5)

Visual field defects 17.4 (4)

Asymptomatic 8.70 (2)

Other symptoms 26.1 (6)

Localization

Frontal 36.4 (8)

Occipital 9.09 (2)

Parietal 13.6 (3)

Brainstem 9.09 (2)

Maillart et al - NEURIMMINFL/2016/009894

Multifocal 31.8 (7)

Gadolinium enhancement , % (N) 54.5 (12)

Post-Nz treatments

Follow-up duration post Nz-PML (month) 25.0 [16.8-32.76]*

Number of MS therapy post Nz-PML 1 [1-2]*

Duration of each MS treatment (month)

Glatiramer Acetate (n=11) 18.37 [7.54-22.70]*

DMF (n=5) 3.22 [3.02-4.80]*

Fg (n=9) 12.12 [8.03-18.73]*

Interferon beta 1a (n=4) 9.48 [5.90-13.48]*

Interferon beta 1b (n=3) 9.03 [8.94-12.04]*

EDSS at start of the first rescue MS DMT 6.0 [4.0-6.5]*

EDSS at last follow-up 5.75 [4.0-6.88]*

EDSS change 0 [-0.5-0]*

M (SD), mean (Standard Deviation); % (N), percent (number of patients); MS, multiple

sclerosis; PML, progressive multifocal leukoencephalopathy; Nz, natalizumab; DMF,

dimethyl-fumarate; Fg, fingolimod; EDSS change, Difference of EDSS at end of follow-up

and EDSS at start of the first subsequent multiple sclerosis disease modifying therapy; DMT,

disease modifying therapies.

* Median [interquartile range]