Friday, December 19, 2008

Female MS Patient in the US dies from PML after 14 months on Tysabri.

I return from Christmas shopping and find this news bit (from Bloomberg Health New). My heart goes out to this patient's family.

If I remember correctly, this woman began experiencing symptoms of PML in September (information based on a comment left on Kim Fabrizio's blog).

Biogen, Elan Shares Fall After U.S. Tysabri Patient’s Death

By Elizabeth Lopatto

Dec. 19 (Bloomberg) -- Shares of Biogen Idec Inc. and Elan Corp. fell after Biogen said a multiple sclerosis patient who developed a severe brain infection after taking the drug Tysabri has died.

Biogen declined $1.26, or 2.6 percent, to $46.75 at 4 p.m. in Nasdaq Stock Market composite trading. Elan fell 35 cents, or 7.9 percent, to close at 4.10 euros in Dublin trading.

Cambridge, Massachusetts-based Biogen was informed of the American woman’s death two days ago, company spokeswoman Naomi Aoki said in an interview. The company reported on Oct. 29 that the patient had been diagnosed with the brain illness, progressive multifocal leukoencephalopathy. The death is the first among four cases of the brain illness reported since Tysabri was reintroduced in the U.S. in 2006.

“Given the expected negative attention that this death will attract in the medical literature and media, we believe there is increased risk to owning shares of both Biogen and Elan,” wrote Christopher James, an analyst for Rodman and Renshaw, in a note to investors.

Tysabri generated $597 million in sales in the first nine months of the year. It is Biogen’s second-best-selling medicine after the MS drug Avonex. Biogen and its marketing partner, Irish drugmaker Elan, pulled Tysabri from the market in February 2005 after three patients, two of whom died, contracted PML.

The patient had received 14 Tysabri infusions before becoming ill, Biogen reported in a regulatory filing in October. Aoki declined to comment on the type of treatment for PML the patient received.

Since Tysabri’s reintroduction, three European patients have contracted PML. Biogen and Elan reported one case on Dec. 15 and two others on July 31.

48,000 Patients

More than 48,000 patients have taken Tysabri, Biogen told investors on Oct. 21, when the company released its earnings. Chief Executive Officer James Mullen said 100,000 patients will be taking the drug by 2010.

PML is included in Tysabri’s prescribing information as a possible side effect in 1 of every 1,000 patients taking the drug. The condition occurs when the JC virus, named with initials for the first patient diagnosed with it, evades the body’s immune defenses and penetrates the brain, causing irreversible damage.

The U.S. Food and Drug Administration approved Tysabri’s return to the market in June 2006 because research showed the treatment is twice as effective as other MS drugs. At the same time, the agency mandated strict measures to monitor side effects.

Neurological Disorder

MS is a neurological disorder that robs people of muscle control and balance, sometimes leading to damaged vision and paralysis. The disease, which affects about 2.5 million people worldwide, is caused when the body’s immune system attacks the protective coating of nerve fibers.

Tysabri, given intravenously once a month, is designed to suppress the immune assault and is one of five immune-suppressing therapies that are known to cause PML. The others are Roche Holding AG’s CellCept, Biogen and Genentech Inc.’s Rituxan, Genzyme Corp.’s Campath and Genentech’s Raptiva.

To contact the reporter on this story: Elizabeth Lopatto in New York at

Last Updated: December 19, 2008 16:21 EST

Another version of the same story:

Biogen says Tysabri PML patient dies in U.S.

Fri Dec 19, 2008 4:52pm EST
By Toni Clarke

BOSTON (Reuters) - Biogen Idec Inc said on Friday that a multiple sclerosis patient who had been diagnosed with a rare brain infection while taking its drug Tysabri has died, sending the company's shares down nearly 3 percent.

Biogen and its partner Elan Corp Plc disclosed the case in October. Naomi Aoki, a spokeswoman for Biogen, said the company learned of the patient's death earlier this week.

Tysabri is seen as crucial to the growth of both companies. The drug was temporarily withdrawn from the market in 2005 after it was linked with a rare brain infection known as progressive multifocal leukoencephalopathy, or PML.

The drug was reintroduced in July 2006 with stricter safety warnings.

So far, there have been four new cases of PML, an infection rate that is still less than the one in 1,000 warned of in the drug's label. Nearly 18,000 patients have received at least a year of Tysabri. But investors are watching to see if the rate increases, and they are also looking at how successfully patients can recover.

"While we continue to believe the benefit/risk profile of Tysabri as favorable, we believe this death could lead the FDA and physicians to alter how future PML cases are managed," said Christopher James, an analyst at Rodman & Renshaw.

The patient who died was a United States patient who had received 14 monthly infusions of Tysabri as a stand-alone treatment. Previously she had received other therapies.

After developing the brain infection, the patient was treated with a procedure known as plasmapheresis, in which blood is removed, cleared of the drug, and replaced.

While the U.S. patient died, two patients who developed PML in Europe, and whose cases were announced in July, appear to be recovering following treatment, even though one had not been expected to survive. Earlier this month, Biogen announced that a fourth patient had developed PML. This patient, in Europe, is still alive.

The European patient that had not been expected to survive had developed a condition known as immune reconstitution inflammatory syndrome, or IRIS. This occurs when the immune system, in eliminating an infection, produces an excessive inflammatory response that can worsen symptoms.

The patient was treated with corticosteroids.

Geoff Meacham, an analyst at J.P. Morgan, said it seems likely the U.S. patient, having gone through plasmapheresis, died of IRIS, and that since the European patient recovered, it might be possible to manage IRIS using steroids and close monitoring. Biogen declined to confirm this theory, citing patient privacy.

"In our view, the rate of PML is now critical to assessing the launch trajectory, and the regulatory outlook, should it stay in the 1/1000 range," Meacham said in a research note.

© Thomson Reuters 2008. All rights reserved.


  1. Scary, scary stuff. Given the way I feel today after my Avonex shot, I can't help but wonder what this stuff too is doing to me longterm.

  2. Lisa,

    Thanks for posting this info. I'm on Tysabri and have been for almost two years. It has me concerned but I know the benefits for me far outweigh the risks. There are risks in everything, including crossing the street.
    I know that from personal experience when I became a hood ornament on someone's car.

  3. Rich, as you already know there are unpleasant side-effects with any of the beta interferon drugs (which is why I use Copaxone). My hope is that these drugs are protecting us from damage longterm.

    Cathy, so glad to see you come by to comment. All of the news exposure which Tysabri/Elan has been getting in the past 2 weeks has me slightly confused and concerned.

    Starting with the news that there were 22 "suspected PML" cases reported to the FDA between the 2006 relaunch and beginning of Oct 2008. Investors theorized that it was a "hit piece" coordinated by a competing pharma company.

    Then the articles complaining of C-level mismanagement and Elan closing offices. And this week, the pieces highlighting the brain infection risk of Tysabri again, finally culminating in this announcement regarding the woman's death.

    There's really not much positive 'PR' done to emphasize the efficacy of Tysabri. Where is Biogen's support?

    Too many unanswered questions.

    But, I'm absolutely glad that Tysabri is working so well for you!!! And, hey, I'm looking forward to seeing what you do with being a Tysabri patient advocate. Talk more about that please.