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Incidence and risk factors for progressive multifocal leukoencephalopathy among patients with selected rheumatic

A Bharat1, F Xie, J W Baddley

  • 1University of Alabama at Birmingham, AL, USA.

Arthritis Care & Research
|December 14, 2011
PubMed
Abstract

Insights

Progressive multifocal leukoencephalopathy (PML) is rare in rheumatic disease patients. A small number of cases occurred in those without HIV or cancer, some linked to biologic therapies like rituximab.

Area of Science:

  • Immunology
  • Neurology
  • Rheumatology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, opportunistic demyelinating disease of the central nervous system.
  • Patients with autoimmune diseases, particularly those treated with immunosuppressive therapies, may be at increased risk.
  • Understanding PML incidence in rheumatic disease populations is crucial for risk assessment and management.

Purpose of the Study:

  • To determine the incidence of PML in patients with specific rheumatic diseases.
  • To characterize PML cases within this patient cohort.
  • To assess the association between biologic therapies (rituximab, TNF antagonists) and PML development.

Main Methods:

  • A population-based study utilizing national Medicare data (2000-2009).
  • Inclusion of patients with rheumatoid arthritis, psoriatic arthritis, psoriasis, juvenile idiopathic arthritis, inflammatory bowel disease, and ankylosing spondylitis.
  • Identification of suspected PML cases via diagnosis codes and risk factor analysis using outpatient data.

Main Results:

  • A total of 53 PML cases were identified among 2,030,578 patients (incidence: 2.6 per 100,000).
  • Most PML cases were associated with human immunodeficiency virus (HIV) and/or cancer.
  • Nine cases involved prior biologic use; three cases without HIV/cancer were linked to rituximab or other biologics within 6-12 months prior to diagnosis.

Conclusions:

  • PML incidence is very low in patients with rheumatic diseases.
  • PML can occur in rheumatic disease patients even without HIV or malignancy.
  • Biologic therapies may be associated with PML in a subset of patients.

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