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Incidence of PML in Finland in 2004-2014
Author(s): ,
J. Sipilä
Affiliations:
Neurology, North Karelia Central Hospital, Joensuu; Neurology, University of Turku; Division of Clinical Neurosciences
,
M. Soilu-Hänninen
Affiliations:
Neurology, University of Turku; Division of Clinical Neurosciences
,
R. Päivi
Affiliations:
Clinical Research Center, Turku University Hospital; Public Health, University of Turku
V. Kytö
Affiliations:
Heart Center, Turku University Hospital; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
ECTRIMS Online Library. Sipilä J. Oct 12, 2018; 229095
Jussi Sipilä
Jussi Sipilä
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Abstract: P1255

Type: Poster Sessions

Abstract Category: Therapy - Risk management for disease modifying treatments

Objective: To determine the incidence trends of progressive multifocal leukoencephalopathy (PML) in Finland (HD).
Background: PML incidence has increased in Sweden from 2004 to 2014, coinciding with prior use of monoclonal antibody treatment. Use of immunosuppressive and -modulating treatments, including second-line treatments for multiple sclerosis (MS) have increased in Finland but PML epidemiology is unknown. Natalizumab was introduced in 2006 and has reached a stable level of 300-400 patients receiving the drug.
Methods: We identified all patients treated for PML (ICD-10 code A81.2) on neurology and internal medicine wards in Finland in 2004-2014 from the national inpatient registry. Predisposing diagnoses (primary diagnosis and auxiliary diagnoses 1&2 were included) were analysed. Hospital transfers were combined and only one admission/person/year was included. Cases with no recorded diagnosis known to predispose to PML were excluded.
Results: We identified 35 persons (57% male) treated for PML yielding an annual incidence of 0.059/100'000 person-years for the study period. Excluding the aberrant case peak in 2010 and 2011 with 8 and 9 annual cases, respectively (49% of all cases), there were 0-4 admissions per year: 0.031/100'000 person-years (95% CI 0.012-0.051) in 2004-2009 and 0.049/100'000 person-years (95% CI 0.015-0.083) in 2012-2014. Mean age was 57 years (standard deviation 17.7; range 22-88 years) with no difference between genders (p=0.42). The majority (71%) of cases were treated on neurology wards. Predisposing conditions were most often neoplasms (ICD-10 group C00-D48, 21 cases or 60% with human immunodeficiency virus (HIV) infection (ICD-10 diagnoses B22-B24, 6 cases or 17%), Systemic connective tissue disorders (ICD-10 codes M30-M35; 5 cases or 14%, consisting of 1 polyarteritis nodosa, 2 systemic lupuses, 1 dermatomyositis and 1 Behçet´s disease) and multiple sclerosis (ICD-10 G35; 3 cases or 9%, all in 2010-2011) trailing. Two (6%) of the 35 patients died while in hospital, both men with a primary diagnosis of HIV (27 and 36 years of age).
Conclusions: We found a low incidence of PML in Finland in 2004-2014 with no convincing trend. The aberrant 2010-2011 case peak might be associated changes in John Cunningham virus (JCV) testing methods. In nearly two thirds of cases, a neoplasm was identified as the predisposing condition with nearly all the rest associated with either HIV or systemic autoimmune diseases.
Disclosure: J.O.T.S.: has received travel grants and congress fee covering (Orion Corporation, Abbvie, Lundbeck, Merck Serono, Sanquin) and holds shares (Orion Corporation). M.S.-H.: has received congress fee covering, investigator fees and honoraria for lectures or advisory boards (Biogen, Merck, Novartis, Roche, Sanofi- Genzyme, Teva). P.R.: has received congress fee covering (Roche, The Finnish Innovation Fund Sitra). V.K.: none.

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