Dr. Baddley has served as a consultant on the Merck Advisory Board and received a fee (less than $10,000).
Incidence and risk factors for Progressive Multifocal Leukoencephalopathy among patients with selected rheumatic diseases
Article first published online: 27 MAR 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 4, pages 612–615, April 2012
How to Cite
Bharat, A., Xie, F., Baddley, J. W., Beukelman, T., Chen, L., Calabrese, L., Delzell, E., Grijalva, C. G., Patkar, N. M., Saag, K., Winthrop, K. L. and Curtis, J. R. (2012), Incidence and risk factors for Progressive Multifocal Leukoencephalopathy among patients with selected rheumatic diseases. Arthritis Care Res, 64: 612–615. doi: 10.1002/acr.21564
- Issue published online: 27 MAR 2012
- Article first published online: 27 MAR 2012
- Accepted manuscript online: 12 DEC 2011 01:10PM EST
- Manuscript Accepted: 5 DEC 2011
- Manuscript Received: 6 JUN 2011
- Agency for Healthcare Research and Quality. Grant Numbers: U18-HS17919, R01-HS018517, 1K08HS017551-01, R01HS018517
- NIHvia the University of Alabama at Birmingham Center for Clinical and Translational Science. Grant Number: 5KL2-RR025776-03
- NIH. Grant Numbers: 5P60AR56116, AR053351
To ascertain the incidence of progressive multifocal leukoencephalopathy (PML) in patients with selected rheumatic diseases, to describe the characteristics of PML cases occurring in this setting, and to evaluate the extent to which such cases occurred in the context of biologic therapies such as rituximab or tumor necrosis factor antagonists.
We conducted a large population-based study to describe the incidence and risk factors for PML among patients with rheumatoid arthritis, psoriatic arthritis, psoriasis, juvenile idiopathic arthritis, inflammatory bowel disease, and ankylosing spondylitis using national inpatient and outpatient administrative data from the entire Center for Medicare and Medicaid Services from 2000–2009. Suspected PML cases were identified using hospital discharge diagnosis codes. Risk factors for PML were evaluated using outpatient data ≥6 months prior to PML diagnosis.
Among 2,030,578 patients with autoimmune diseases of interest, a total of 53 PML cases were identified (2.6 per 100,000 patients). Most PML cases had human immunodeficiency virus (HIV) and/or cancer. Nine PML cases had evidence for biologic use prior to PML hospitalization, of which 3 had neither HIV nor malignancy and were exposed to biologics within 12 (rituximab) or 6 months (all other biologics) prior to PML diagnosis. PML occurred at an estimated incidence of 0.2 per 100,000 patients with autoimmune diseases who did not have HIV or malignancy.
PML occurs at a very low incidence among patients with rheumatic diseases but can occur even in the absence of HIV or malignancy.