Incidence and risk factors for progressive multifocal leukoencephalopathy among patients with selected rheumatic diseases

A. Bharat, F. Xie, J. W. Baddley, T. Beukelman, L. Chen, L. Calabrese, E. Delzell, C. G. Grijalva, N. M. Patkar, K. Saag, Kevin Winthrop, J. R. Curtis

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Abstract

Objective. 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. Methods. 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. Results. 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. Conclusion. PML occurs at a very low incidence among patients with rheumatic diseases but can occur even in the absence of HIV or malignancy.

Original languageEnglish (US)
Pages (from-to)612-615
Number of pages4
JournalArthritis Care and Research
Volume64
Issue number4
DOIs
StatePublished - Apr 2012

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Progressive Multifocal Leukoencephalopathy
Rheumatic Diseases
Incidence
HIV
Biological Products
Autoimmune Diseases
Neoplasms
Outpatients
Centers for Medicare and Medicaid Services (U.S.)
Psoriatic Arthritis
Biological Therapy
Juvenile Arthritis
Ankylosing Spondylitis
Inflammatory Bowel Diseases
Psoriasis

ASJC Scopus subject areas

  • Rheumatology

Cite this

Bharat, A., Xie, F., Baddley, J. W., Beukelman, T., Chen, L., Calabrese, L., ... Curtis, J. R. (2012). Incidence and risk factors for progressive multifocal leukoencephalopathy among patients with selected rheumatic diseases. Arthritis Care and Research, 64(4), 612-615. https://doi.org/10.1002/acr.21564

Incidence and risk factors for progressive multifocal leukoencephalopathy among patients with selected rheumatic diseases. / Bharat, A.; Xie, F.; Baddley, J. W.; Beukelman, T.; Chen, L.; Calabrese, L.; Delzell, E.; Grijalva, C. G.; Patkar, N. M.; Saag, K.; Winthrop, Kevin; Curtis, J. R.

In: Arthritis Care and Research, Vol. 64, No. 4, 04.2012, p. 612-615.

Research output: Contribution to journalArticle

Bharat, A, Xie, F, Baddley, JW, Beukelman, T, Chen, L, Calabrese, L, Delzell, E, Grijalva, CG, Patkar, NM, Saag, K, Winthrop, K & Curtis, JR 2012, 'Incidence and risk factors for progressive multifocal leukoencephalopathy among patients with selected rheumatic diseases', Arthritis Care and Research, vol. 64, no. 4, pp. 612-615. https://doi.org/10.1002/acr.21564
Bharat, A. ; Xie, F. ; Baddley, J. W. ; Beukelman, T. ; Chen, L. ; Calabrese, L. ; Delzell, E. ; Grijalva, C. G. ; Patkar, N. M. ; Saag, K. ; Winthrop, Kevin ; Curtis, J. R. / Incidence and risk factors for progressive multifocal leukoencephalopathy among patients with selected rheumatic diseases. In: Arthritis Care and Research. 2012 ; Vol. 64, No. 4. pp. 612-615.
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AU - Xie, F.

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AU - Beukelman, T.

AU - Chen, L.

AU - Calabrese, L.

AU - Delzell, E.

AU - Grijalva, C. G.

AU - Patkar, N. M.

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AU - Winthrop, Kevin

AU - Curtis, J. R.

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