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Such patients should probably undergo a lumbar puncture, with measurement of CSF for JCV polymerase chain reaction, before starting alemtuzumab or any other potent immunosuppressant, as a precautionary measure

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Other glucose-lowering medication classes that may be considered include: SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin), which offer cardiovascular and renal benefits with a different side effect profile (primarily genital infections and increased urination)

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doi: 10.1016/j.clineuro.2022.107177 [113] Kurd SK, et al