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The national incidence of PML in Sweden, 1988-2013
Department of Clinical Neuroscience, Division of Neurology, Karolinska Institutet, Stockholm, Sweden.
Center for Pharmacoepidemiolog, Karolinska Institutet, Stockholm, Sweden.
Center for Pharmacoepidemiolog, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neuroscience, Division of Neurology, Karolinska Institutet, Stockholm, Sweden.
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2018 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 90, no 6, p. E498-E506Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the incidence of progressive multifocal leukoencephalopathy (PML) and patient characteristics in Sweden between 1988 and 2013.

Methods: All PML diagnoses in Sweden between 1988 and 2013 were identified in the National Patient Register. Information to validate the diagnosis and patient characteristics was obtained from medical records.

Results: Medical record review classified 108 out of 250 patients (43%) as definite (n = 84), probable (n = 4), or possible (n = 20) PML according to diagnostic criteria. Accurate diagnoses were more common in records obtained from neurology departments (82% of patients seen in neurology departments) compared with other departments (31%) (p < 0.001). The incidence of PML increased from a largely stable level at 0.026 (95% confidence interval [CI] 0.021-0.031) per 100,000 individuals per year during 1988-2010 to 0.11 (95% CI 083-0.137) during 2011-2013, during which time there was a notable increase (p < 0.001). Hematologic malignancies (n = 34), HIV/AIDS (n = 33), and autoimmune disease (n = 23) were the most common underlying diseases. Treatment with a monoclonal antibody prior to PML diagnosis was identified in 26 patients.

Conclusion: An increased incidence of PML in Sweden was observed and coincided with the prior use of monoclonal antibody treatment. The high level of misdiagnosis emphasizes the importance of immediate contact with a neurology center upon suspicion of PML.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018. Vol. 90, no 6, p. E498-E506
National Category
Neurology
Identifiers
URN: urn:nbn:se:oru:diva-66935DOI: 10.1212/WNL.0000000000004926ISI: 000427800200007PubMedID: 29321229OAI: oai:DiVA.org:oru-66935DiVA, id: diva2:1205489
Funder
The Swedish Brain Foundation
Note

Funding Agencies:

F. Hoffmann-La Roche Ltd.  

Stockholm County Council  

Swedish Medical Research Council  

Karolinska Institutet 

Available from: 2018-05-14 Created: 2018-05-14 Last updated: 2018-09-04Bibliographically approved

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Montgomery, Scott

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