Published: 3 March 2016

Publications

Reminder: Immunomodulatory Medicines and Risk of Progressive Multifocal Leukoencephalopathy

This article is more than five years old. Some content may no longer be current.

Prescriber Update 37(1): 10
March 2016

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system. PML is caused by the human polyomavirus John Cunningham (JC) virus and may be fatal or result in severe disability.

A compromised immune system due to either disease or immunomodulatory medicines is the major risk factor for development of PML¹. Cases of PML have been reported in individuals with HIV, lymphoproliferative disorders and malignancies¹.

Medicines associated with an increased risk of PML, either alone or with other immunomodulatory medicines, include:

• fingolimod
• azathioprine
• natalizumab
• rituximab
• dimethyl fumarate
• alemtuzumab
• mycophenolate mofetil
• cyclophosphamide
• tacrolimus.

PML should be considered in patients with compromised immune systems that present with progressive neurological signs or symptoms including cognitive dysfunction, and motor and sensory disturbance¹.

More detailed information on PML can be found in the 2012 Prescriber Update article ‘PML: A rare but serious disease’¹.

References

1. Medsafe. 2012. PML: A Rare but Serious Disease. Prescriber Update 33(3): 21-23. URL: www.medsafe.govt.nz/profs/PUArticles/PMLSept2012.htm (accessed 3 November 2015).