scholarly journals Infectious Risk Mitigation in Patients with Multiple Sclerosis under Disease-Modifying Therapies – the Experience of a Collaborative Neurology-Infectious Diseases Approach

2021 ◽  
Vol 13 ◽  
pp. 117957352110421
Author(s):  
Daniela Ferro ◽  
Beatriz Prista-Leão ◽  
Andreia Costa ◽  
André Silva-Pinto ◽  
Cândida Abreu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Infectious Diseases ◽  
Jc Virus ◽  
Risk Mitigation ◽  
Latent Tuberculosis ◽  
Interdisciplinary Approach ◽  
Infectious Risk ◽  
Disease Modifying Therapies ◽  
Disease Modifying ◽  
Clinical Records

Background Multiple sclerosis treatment has changed in the last years with the emergence of new disease-modifying therapies (DMTs). Despite a better efficacy profile, these drugs raise concerns about infectious risk, which needs to be mitigated. Objective To analyze the results of a systematic collaborative approach between Neurology and Infectious Diseases (ID) Departments in the management of infectious risk and complications in MS patients treated with DMT. Methods Retrospective collection of MS patients’ demographic and clinical data from clinical records of MS and ID outpatient clinics (2011–2017). Results We included 149 patients: most had evidence of previous contact with Herpesviridae, and half of them were not immune to hepatitis A and B viruses (HAV and HBV). Vaccines for HAV, HBV, and Streptococcus pneumoniae were administered in 91%, 78%, and 88% of non-immune patients, respectively. JC virus serology monitoring prevented natalizumab (NTZ) initiation or prompted its switch in 34/122 patients. Forty patients had latent tuberculosis, in which 88% were treated. Infectious events occurred in 33 patients, mostly mild urinary, respiratory, and herpes virus group infections. Only three patients required inpatient care. Conclusion Facing the expansion of the new DMT, we highlight the benefits of an interdisciplinary approach for safer use of the chosen treatment.

Assessment and management of infectious risk in multiple sclerosis patients treated with disease-modifying therapies

2021 ◽  
Vol 429 ◽  
pp. 117753
Author(s):  
Maria Antonella Zingaropoli ◽  
Patrizia Pasculli ◽  
Marco Iannetta ◽  
Valentina Perri ◽  
Matteo Tartaglia ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Infectious Risk ◽  
Disease Modifying Therapies ◽  
Disease Modifying ◽  
Multiple Sclerosis Patients

scholarly journals Infectious risk in multiple sclerosis patients treated with disease-modifying therapies: A three-year observational cohort study

2022 ◽  
Vol 8 (1) ◽  
pp. 205521732110657
Author(s):  
Maria Antonella Zingaropoli ◽  
Patrizia Pasculli ◽  
Marco Iannetta ◽  
Valentina Perri ◽  
Matteo Tartaglia ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cohort Study ◽  
Treated Patient ◽  
Observational Cohort Study ◽  
Hbv Reactivation ◽  
Infectious Risk ◽  
Disease Modifying Therapies ◽  
Observational Cohort ◽  
Disease Modifying ◽  
Multiple Sclerosis Patients

Background The disease-modifying therapies (DMTs) largely used in multiple sclerosis (MS) may result in higher infectious risk. Objective We aimed to investigate the infectious risk in DMT-treated MS patients. Methods MS patients were evaluated for infectious risk before starting, switching or during DMT. Results In this three-year observational cohort study 174 MS patients were enrolled. Among them, 18 patients were anti-HBc + and 19 patients were QuantiFERON®-TB Gold In-Tube (QFT)  +  . No patients with anti-HBc + showed a detectable HBV-DNA and all started DMT. Among QTB + patients, 17 latent TB infections (LTBIs) and 2 active TB infections (TBIs) were identified. After one month of LTBI prophylaxis or TB treatment, respectively, all patients started DMTs. Overall, 149 started DMTs. During DMTs, one ocrelizumab-treated patient with anti-HBc + developed HBV reactivation and six patients (3 on natalizumab, 2 on ocrelizumab and 1 on IFN-β) showed reactivation of HSV-1, with detectable plasma DNA. Finally, 1 cladribine-treated patient experienced VZV reactivation. All the reactivations of latent infections have been successfully treated. Conclusion Screening of infectious diseases in DMT candidate MS patients helps to mitigate the infectious risk. During DMTs, a regular assessment of infectious risk allows to avoid discontinuing MS therapy and guarantees a higher degree of safety.

LATENT TUBERCULOSIS INFECTION REACTIVATION IN PATIENTS WITH MULTIPLE SCLEROSIS IN USE OF DISEASE-MODIFYING THERAPIES: A SYSTEMATIC REVIEW

2021 ◽  
pp. 103184
Author(s):  
Luiza Andraus Dantas ◽  
Marina Steingraber Pereira ◽  
Amanda de Miranda Gauza ◽  
Maria Eduarda Bonetti Schulz ◽  
Gustavo Figueiredo da Silva ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Disease Modifying Therapies ◽  
Disease Modifying

Update on disease-modifying therapies for multiple sclerosis

2017 ◽  
Vol 65 (5) ◽  
pp. 883-891 ◽  
Author(s):  
Diana L Vargas ◽  
William R Tyor
Keyword(s):  
Multiple Sclerosis ◽  
Inflammatory Response ◽  
Demyelinating Disease ◽  
Jc Virus ◽  
Healthcare Providers ◽  
White Matter Lesions ◽  
Adequate Treatment ◽  
Disease Modifying Therapies ◽  
Oral Agents ◽  
Disease Modifying

Multiple sclerosis (MS) is an autoimmune, demyelinating disease of the central nervous system (CNS). It predominantly affects young women and is one of the most common causes of disability in young adults. MS is characterized by formation of white matter lesions in the CNS as a result of inflammation, demyelination, and axonal loss. Treatment has been a focus of neurological research for over 60 years. A number of disease-modifying therapies (DMTs) have become available making MS a treatable disease. These compounds target the inflammatory response in MS. They work by decreasing the chances of relapse, decreasing the chances of new lesion formation seen on MRI of the CNS and slowing the accumulation of disability. The first drugs for MS to be available were interferon-β and glatiramer acetate. These work by modulating the inflammatory response via different mechanisms that are briefly discussed. Newer agents have since become available and have significantly changed the dynamics of MS treatment. These include fingolimod, dimethyl fumarate and teriflunomide, which are oral agents. Other second-line and third-line Food and Drug Administration (FDA) approved medications include natalizumab and alemtuzumab. Natalizumab is considered one of the most potent treatments for relapse prevention. However, the high risk of progressive multifocal leukoencephalopathy (PML), which is caused by JC virus infection in the brain, tempers the more widespread use of this agent; nevertheless, JC virus antibody tests have helped to stratify the risk of PML. Alemtuzumab, which also has a considerable side effect profile, is likewise highly efficacious. Ocrelizumab, a monoclonal antibody to CD20 on B cells, is a highly effective agent for MS that is likely to be approved soon by the FDA. MS is a major contributor to healthcare costs and it is critical that healthcare providers be aware of the availability and benefits of DMTs. It is imperative that prompt and adequate treatment be established on diagnosis. Changes in therapy should be considered when there is evidence of disease activity as well as accumulation of disability or safety or tolerability concerns.

scholarly journals Ethical use of off-label disease-modifying therapies for multiple sclerosis

2021 ◽  
pp. 135245852110302
Author(s):  
Joanna Laurson-Doube ◽  
Nick Rijke ◽  
Anne Helme ◽  
Peer Baneke ◽  
Brenda Banwell ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
World Health ◽  
World Federation ◽  
Off Label ◽  
Disease Modifying Therapies ◽  
The World ◽  
Disease Modifying ◽  
Health Organization

Background: Off-label disease-modifying therapies (DMTs) for multiple sclerosis (MS) are used in at least 89 countries. There is a need for structured and transparent evidence-based guidelines to support clinical decision-making, pharmaceutical policies and reimbursement decisions for off-label DMTs. Objectives/Results: The authors put forward general principles for the ethical use of off-label DMTs for treating MS and a process to assess existing evidence and develop recommendations for their use. Conclusion: The principles and process are endorsed by the World Federation of Neurology (WFN), American Academy of Neurology (AAN), European Academy of Neurology (EAN), Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS), European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), Middle-East North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) and Pan-Asian Committee for Treatment and Research in Multiple Sclerosis (PACTRIMS), and we have regularly consulted with the Brain Health Unit, Mental Health and Substance Use Department at the World Health Organization (WHO).

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