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Progressive multifocal leucoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by polyomavirus JC. It results from lytic infection of glial cells and is often fatal.1 ,2 A common risk factor for PML is immunosuppression due to HIV infection or malignancy (or its treatment). PML has also been reported in those using immunomodulation therapies.3 A previous study estimated incidence of PML at 0.2/100 000 among patients with autoimmune diseases who did not have HIV or malignancy. Based on the single case of PML exposed to a biological agent, another study reported the incidence rate (IR) of PML was 2.3 (95% CI 0.1 to 71) per 100 000 person-years in patients who were exposed to biological agents and 0.8 (95% CI 0.2 to 2.5) per 100 000 person-years in those not exposed to biological agents.4
Cases of PML associated …
Contributors MR and JWB provided the study concept and drafting of the manuscript. JWB and JRC supervised the study and critically revised the manuscript for important intellectual content.
Competing interests JWB: He is a consultant for Merck, Pfizer and Astellas. Pending research grant from Bristol-Myers Squibb (BMS). JRC: He receives salary support from National Institutes of Health (AR053351) and Agency for Healthcare Research and Quality (AHRQ) (R01 R01HS018517). He is a consultant and has received research support from Amgen, Janssen, Consortium of Rheumatology Researchers of North America (CORRONA), Pfizer, Roche/Genentech, Abbvie and UCB.
Provenance and peer review Not commissioned; externally peer reviewed.
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