Progressive multifocal leukoencephalopathy in patients with systemic lupus erythematosus: a systematic literature review

Abstract

The evidence from this literature review suggests that, while PML is a very rare disease in SLE patients, there does appear to be an increased risk of PML associated with SLE compared to the general population, potentially due to immunosuppression, other contributing factors in their underlying disease, treatments prescribed to manage disease, or some combination of these factors. Additional large observational studies, designed to assess exposure to drugs of interest and complicated treatment histories, are needed to provide further evidence about potential mechanisms contributing to the onset of PML in SLE patients.

Drug-induced progressive multifocal leukoencephalopathy: a case/noncase study in the French pharmacovigilance database

“…Among the two cases of azathioprine‐induced PML, one was identified in a patient treated exclusively by azathioprine for ulcerative colitis. To our knowledge, this is the first case of PML described with this single use of drug for ulcerative colitis . Immunosuppressant‐induced PML have a long onset time after starting treatment, as reported previously .…”

John Cunningham virus granule cell neuronopathy in a mildly immunosuppressed patient with systemic lupus erythematosus

“…The salient observation in this case is the occurrence of JC virus reactivation in a patient taking a modest amount of maintenance immunosuppressive medication for relatively quiescent SLE. In one review of 35 publications on PML in SLE, most patients were being treated with biological or high‐dose conventional immunosuppressive drugs . However, there were five cases identified with similarly mild immunosuppression (prednisolone dose ≤15 mg/day, with or without methotrexate or hydroxychloroquine).…”

Anti-α4β7 therapy targets lymphoid aggregates in the gastrointestinal tract of HIV-1 infected individuals

“…Advanced HIV-1 infection, which is associated with T cell dysfunction, is a known and significant risk for PML (41). Additionally, azathioprione, an inhibitor of T cell activation, is also a known risk-factor for PML (42). Looking forward, a prudent approach would be to avoid anti-α4β7 therapy in viremic HIV-1 infection, in the presence of concomitant immunosuppression in patients seropositive for John Cunningham virus (JCV).…”