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Table 2: Risk stratification of natalizumab-associated PML
Risk Factors for PML Development in Patients Treated with NTZ Duration of Therapy ≥24 Months
Risk stratification of patients 
    High risk Prior immunosuppressive therapy
Evidence of JCV antibody seropositivity
Presence of anti-JCV antibodies
Increased treatment duration, especially beyond 2 yr
Immunosuppressant use prior to receiving NTZ
High JCV titers
    Low risk Patients negative for anti-JCV antibody (risk is <0.09/1000)
Methods of reducing risk All patients receiving NTZ should be screened for previous JCV infection
Serologic testing for patients negative for JCV every 6 mo
Patients positive for JCV who have been treated with NTZ for >2 yr should be switched to another second-line therapy
Increased frequency of imaging surveillance for high-risk patients (eg, every 3–4 mo)
Comparison of surveillance images with previous MR imaging
Note:—JCV indicates John Cunningham virus.