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The changing landscape of progressive multifocal leukoencephalopathy

Sachin Kedar1, Joseph R Berger

  • 1Department of Neurology, University of Kentucky College of Medicine, 740 S. Limestone St., Lexington, KY, 40515, USA.

Current Infectious Disease Reports
|May 24, 2011
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML), a rare neurologic disease, affects immunosuppressed individuals due to JC virus reactivation. Emerging biologic therapies increase PML risk, necessitating effective prevention strategies.

Area of Science:

  • Neurology
  • Virology
  • Immunology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, severe neurologic disease primarily affecting immunosuppressed individuals.
  • The JC virus (JCV), a common polyomavirus, causes PML through reactivation of latent infection under immunosuppression.
  • The HIV/AIDS pandemic historically increased PML incidence, which declined with highly active antiretroviral treatment (HAART).

Purpose of the Study:

  • To highlight the increasing risk of PML with the introduction of new biologic agents targeting specific immune pathways.
  • To underscore the need for effective risk mitigation strategies for PML prevention in patients receiving these therapies.

Main Methods:

  • Review of existing literature on PML epidemiology and risk factors.
  • Analysis of PML incidence trends associated with different immunosuppressive therapies, including biologic agents.
  • Identification of specific biologic agents, such as natalizumab and efalizumab, associated with the highest PML risk.

Main Results:

  • Biologic agents targeting the immune system are expanding the population at risk for PML.
  • Natalizumab and efalizumab are associated with the highest risk of developing PML among biologic therapies.
  • PML can occur with other biologic agents, indicating a broader risk across this treatment class.

Conclusions:

  • The expanding use of biologic therapies necessitates proactive strategies to manage and prevent PML.
  • Effective risk mitigation is crucial for patients undergoing immunosuppressive therapy with biologic agents.
  • Further research into PML pathogenesis and prevention is warranted given the evolving treatment landscape.

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