Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Characteristics of Cases of PML among Patients with Selected Rheumatic and Autoimmune Diseases.

Beukelman5,  Timothy, Xie3,  Fenglong, Chen3,  Lang, Baddley3,  John, Delzell3,  Elizabeth, Grijalva7,  Carlos G., Patkar2,  Nivedita M.

OHSU
Univ of AL at Birmingham, Birmingham, AL
Univ of AL at Birmingham
University of Alabama - Brimingham, Birmingham, AL
University of Alabama-Birmingham, Birmingham, AL
University of Alabama-Birmingham, Birmingham, AL
Vanderbilt

Background:

The incidence and antecedent risk factors for infection with progressive multifocal leukoencephalopathy (PML) infection have been minimally characterized in patients with rheumatic diseases.

Methods:

Using individually-identifiable, person-level administrative data from the entire United States from the Center for Medicare and Medicaid Services (CMS) from 2000–2006, we identified both Medicaid-only and also 'dual-eligible' (Medicare + Medicaid) individuals with at least one diagnosis of rheumatoid arthritis (RA), psoriatic arthritis (PsA), psoriasis (PsA), juvenvile idiopathic arthritis (JIA), inflammatory bowel disease (IBD), and anklylosing spondylitis (AS) claim at any time. PML was identified using hospital discharge diagnosis codes (ICD9 046.3), and the 'case date' was assigned as the date of hospital admission. Risk factors for PML were evaluated in the 6 months prior to the case date, and separately using all data prior to the case date. During these assessment periods, patients must also have had full insurance coverage (e.g. Medicare Part A+B, not enrolled in Medicare Advantage). 4 month mortality following the case date was described. Data Use Agreement restrictions from the Center for Medicare and Medicaid Services (CMS) required collapsing categories with individual cell sizes < 11.

Results:

Among 712,708 unique individuals with RA, PsA, PsO, JIA, IBD, or AS, a total of 55 hospitalizations for PML were identified (7.7 per 100,000 individuals). Of these cases, 29 had insurance coverage for at least 6 months prior to the PML case date and had one or more physician diagnoses of a rheumatic disease that occurred before the PML case date. Characteristics of these 29 PML cases include mean ± SD age 46.8 ± 8.l8 years, 41% women. There was at least 1 case of PML that occurred among patients with each rheumatic disease studied except for JIA. The most prevalent concomitant comorbidity was HIV (83% of patients). Additional comorbidities present with low prevalence among PML cases included malignancy and concomitant systemic lupus erythematosus. At least one individual with PML had none of these comorbidities nor HIV but was a current user of infliximab.

Among all PML cases, more than 1 patient had antecedent exposure to infliximab in the 6 months prior to the PML case date; the median time from the most recent exposure to infliximab to hospitalization for PML was between 1 and 2 months. No other PML patients had any prior exposure to any other biologic agent. Fewer than 10 patients were using glucocorticoids in the 6 months prior to the PML infection. More than 1/3 of patients died in the 4 months following the PML case date.

Conclusion:

PML is a rare infection that has been observed to occur among patients with inflammatory and autoimmune conditions, even in the absence of recent biologic drug exposure or other risk factors such as HIV disease. A better understanding of the epidemiology of PML infections and associated risk factors may be useful to inform patients regarding this rare but serious adverse event.

To cite this abstract, please use the following information:
Beukelman, Timothy, Xie, Fenglong, Chen, Lang, Baddley, John, Delzell, Elizabeth, Grijalva, Carlos G., et al; Characteristics of Cases of PML among Patients with Selected Rheumatic and Autoimmune Diseases. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :722
DOI: 10.1002/art.28490

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