Pharmacological Treatments Preceding Diagnosis Of Progressive Multifocal Leukencephalopathy

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Burkill, SarahCentre for Pharmocoepodemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (author)

Pharmacological Treatments Preceding Diagnosis Of Progressive Multifocal Leukencephalopathy

Article/chapterEnglish2016

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2016-08-24
Wiley-Blackwell,2016
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LIBRIS-ID:oai:DiVA.org:oru-54324
https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-54324URI
https://doi.org/10.1002/pds.4070DOI

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Language:English
Summary in:English

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Background: Progressive multifocal leukencephalopathy (PML) is a rare, often fatal viral disease, which affects the white matter of the brain. It is caused by John Cunningham (JC) polyomavirus, which is present in most people and is usually harm-less. For immunocompromised persons, such as those who are taking immunosuppressive treatments, the risk of JC virus causing PML is increased, although still rare. As PML diagnosis is not always accurate, epidemiology of PML, including the true incidence and patient characteristics, is incompletely described.Objectives: To identify pharmacological treatments preceding diagnosis of deﬁnitive, probable and possible PML, after excluding incorrect PML diagnoses by medical record review.Methods: Patients with a PML diagnosis in Sweden between 1988 and 2013 were identiﬁed through the Patient register using ICD 9 code 046D and ICD 10code A81.2 (n = 281). Medical records were reviewed and information on clinical characteristics and pharmacological treatments were collected. Each of the diagnoses was determined as deﬁnite PML, possible PML, probable PML or non-PML based on the consensus statement for the AAN neuroinfectious disease section published in 2013. (PMCID: 3662270).Results: Medical records for 251 patients (89%) were available and examined. In total, 84 (33%) of the 251 PML diagnoses were conﬁrmed. For those with a record of being exposed to immunosuppressant drugs, 60 (65%) of the 92 records were conﬁrmed as being deﬁnite PML. Among 12 patients exposed to rituximab 11 (92%) had deﬁnite and 1 (8%) had probable PML. For the 9 natalizumab users, 8 (89%) had deﬁnite PML and 1 (11%) was diagnosed incorrectly.Conclusions: A substantial proportion of PML diagnoses recorded in Sweden are incorrect, however amongst those exposed to immunosuppressants such as rituximab and natalizumab the majority of diagnoses are correct. Assessing immunosuppressive drug history could be an important part of the diagnostic processes for PML.

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Iacobaeus, EllenDepartment of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden (author)
Bahmanyar, ShahramCentre for Pharmocoepodemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (author)
Brundin, LouDepartment of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden (author)
Fored, MichaelClinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (author)
Olsson, TomasDepartment of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden (author)
Montgomery, Scott,1961-Örebro universitet,Institutionen för medicinska vetenskaper,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Clinical Epidemology and Biostatistics(Swepub:oru)smy (author)
Centre for Pharmocoepodemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, SwedenDepartment of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden (creator_code:org_t)

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In:Pharmacoepidemiology and Drug Safety: Wiley-Blackwell25:Suppl. 3, s. 496-4971053-85691099-1557

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