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Pharmacological Treatments Preceding Diagnosis Of Progressive Multifocal Leukencephalopathy
Centre for Pharmocoepodemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.
Centre for Pharmocoepodemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.
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2016 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 25, no Suppl. 3, 496-497 p.Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016. Vol. 25, no Suppl. 3, 496-497 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:oru:diva-54324DOI: 10.1002/pds.4070ISI: 000385483503118OAI: oai:DiVA.org:oru-54324DiVA: diva2:1063234
Available from: 2017-01-09 Created: 2017-01-09 Last updated: 2017-01-09Bibliographically approved

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