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Progressive multifocal leukoencephalopathy and reversible progressive leukoencephalopathy syndrome in dermatologic

Barry Ladizinski1, Misha M Heller, Tina Bhutani

  • 1DermSurgery Associates, Houston, TX , USA.

Journal of Drugs in Dermatology : JDD
|February 5, 2013
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML) and reversible progressive leukoencephalopathy syndrome (RPLS) are serious neurological conditions. This review examines the potential risks associated with systemic psoriasis treatments, including biologics, and their link to these disorders.

Area of Science:

  • Neurology
  • Immunology
  • Dermatology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease caused by John Cunningham virus reactivation, primarily in immunocompromised individuals.
  • Reversible progressive leukoencephalopathy syndrome (RPLS) is a treatable condition characterized by neurological symptoms and cerebral edema, often linked to hypertension and immunosuppression.
  • Concerns have risen in dermatology regarding systemic psoriasis treatments and their potential association with PML and RPLS.

Purpose of the Study:

  • To review the association between prebiologic and biologic therapies used for psoriasis and the risk of developing PML and RPLS.
  • To evaluate the safety profile of various systemic medications in the context of these neurological conditions.

Main Methods:

  • Literature review of prebiologic (cyclosporine, methotrexate, acitretin) and biologic (adalimumab, alefacept, efalizumab, etanercept, infliximab, rituximab, ustekinumab) agents.
  • Analysis of reported cases and warnings concerning PML and RPLS in patients using these treatments.

Main Results:

  • Efalizumab was withdrawn due to PML association; ustekinumab carries an RPLS warning.
  • The review critically examines the potential for other systemic agents to increase the risk of PML and RPLS.

Conclusions:

  • Further investigation is warranted to fully understand the risk of PML and RPLS associated with systemic psoriasis treatments.
  • Clinicians should carefully weigh the benefits and risks of these medications, considering patient-specific factors and potential neurological adverse effects.

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