Immune checkpoints inhibitors in the treatment of progressive multifocal leukoencephalopathy: A systematic review and meta-analysis.
Ahmad Toubasi, Thuraya N Al-Sayegh
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In 30 seconds
This systematic review and meta-analysis assessed immune checkpoint inhibitors (ICIs) for progressive multifocal leukoencephalopathy (PML), pooling reports involving 186 patients from 52 articles. The pooled survival rate was 62% (95%CI: 52%-72%). Disability did not differ significantly before and after ICI treatment (WMD =- 0.03; 95%CI: - 2.11-2.04), while ICI use was associated with lower cerebrospinal fluid viral levels (WMD = 69.20; 95%CI: 1.69-136.70). The authors call for randomized trials or comparative observational studies against other treatment approaches.
Key findings
- Across 186 patients from 52 articles, the pooled survival rate was 62% (95%CI: 52%-72%).
- Disability showed no significant pre- versus post-treatment difference (WMD =- 0.03; 95%CI: - 2.11-2.04).
- ICI treatment was associated with lower CSF viral levels (WMD = 69.20; 95%CI: 1.69-136.70).
Why it matters
PML has no established effective treatment, and these pooled reports provide an overview of outcomes observed with ICIs. The findings suggest a possible virological signal, but the absence of a significant disability change and the lack of comparative evidence mean that survival and viral-load results should not be interpreted as proof of clinical benefit.
What to keep in mind
The evidence was pooled from 52 articles rather than randomized or comparative studies; the authors state that such studies are needed to assess efficacy against other treatment modalities.