Analysis on clinical characteristics of rituximab-related progressive multifocal leukoencephalopathy in patients with rheumatoid arthritis
10.3760/cma.j.cn114015-20211227-01302
- VernacularTitle:类风湿关节炎患者利妥昔单抗相关进行性多灶性白质脑病的临床特点分析
- Author:
Jiyu LIU
1
;
Li ZHAO
1
;
Hejian ZOU
1
;
Yu XUE
1
Author Information
1. 复旦大学附属华山医院风湿免疫科，复旦大学风湿免疫过敏性疾病研究中心，上海 200040
- Publication Type:Journal Article
- Keywords:
Arthritis, rheumatoid;
Leukoencephalopathy, progressive multifocal;
Rituximab
- From:
Adverse Drug Reactions Journal
2022;24(10):534-539
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics of rituximab-related progressive multifocal leukoencephalopathy (PML) in patients with rheumatoid arthritis (RA).Methods:The relevant domestic and international databases (as of November 2021) were searched and case reports on PML in RA patients treated with rituximab were collected. Clinical data such as gender, age, underlying disease, use of rituximab, combination drugs, time to onset of PML, clinical manifestations, results of ancillary examinations(imaging, cerebrospinal fluid), intervention and prognosis were extracted and analyzed descriptively.Results:A total of 10 patients were enrolled in the study, including 1 male and 9 females, aged from 51 to 83 years with an average of 66 years. All of the patients were suffering from moderate to severe RA, 9 of which had a disease duration of ≥3 years and 1 had no disease duration record. The usage and dosage of rituximab in the 10 patients were in accordance with the instructions, and all the patients received combined medication with conventional synthetic disease-modifying anti-rheumatic drugs or glucocorticoids. The time from the last dose of rituximab to the onset of PML was recorded in 9 patients, which were 2-8, 16, and 18 months in 7, 1, and 1 patient respectively, with a median time of 6 months. Clinical symptoms were recorded in 6 patients, mainly including ataxia, speech disorders, cognitive impairment, and focal sensory deficits, etc. Six patients had head magnetic resonance imaging, and all of the results were consistent with the imaging changes of PML. Four patients had cerebrospinal fluid anti-John Cunningham virus test, which were positive for viral DNA in 3 patients and negative in 1 patient (the patient was diagnosed with PML by brain tissue biopsy). After the diagnosis of PML, 1 patient received no intervention, 3 had no record of intervention measures, 5 were treated with mefloquine and mirtazapine alone or in combination (2 of which were combined with plasma exchange and 1 with glucocorticoids), and 1 was treated with mirtazapine and nitrofurantoin in combination. Seven patients died due to ineffective treatment, 2 survived but had severe neurological sequelae, and the final outcome of 1 patient was not reported.Conclusions:Rituximab-related PML mostly occurs 2 to 8 months after the last application of the drug, which has similar clinical manifestations and imaging to that due to other causes and usually aggravate progressively with a high mortality rate. The survivors may have severe neurological sequelae.
