Elena Grebenciucova1, Amy Pruitt2. 1. Multiple Sclerosis Division, Davee Department of Neurology and Clinical Neurosciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA. elena.grebenciucova@northwestern.edu. 2. Multiple Sclerosis Division, the Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, 3400 Convention Avenue, Philadelphia, PA, 19104, USA.
Abstract
PURPOSE OF REVIEW: This paper will systemically review the risk of infections associated with current disease-modifying treatments and will discuss pre-treatment testing recommendations, infection monitoring strategies, and patient education. RECENT FINDINGS: Aside from glatiramer acetate and interferon-beta therapies, all other multiple sclerosis treatments to various degrees impair immune surveillance and may predispose patients to the development of both community-acquired and opportunistic infections. Some of these infections are rarely seen in neurologic practice, and neurologists should be aware of how to monitor for these infections and how to educate patients about medication-specific risks. Of particular interest in this discussion is the risk of PML in association with the recently approved B cell depleting therapy, ocrelizumab, particularly when switching from natalizumab. The risk of infection in association with MS treatments has become one of the most important factors in the choice of therapy. Balance of the overall risk versus benefit should be continuously re-evaluated during treatment.
PURPOSE OF REVIEW: This paper will systemically review the risk of infections associated with current disease-modifying treatments and will discuss pre-treatment testing recommendations, infection monitoring strategies, and patient education. RECENT FINDINGS: Aside from glatiramer acetate and interferon-beta therapies, all other multiple sclerosis treatments to various degrees impair immune surveillance and may predispose patients to the development of both community-acquired and opportunistic infections. Some of these infections are rarely seen in neurologic practice, and neurologists should be aware of how to monitor for these infections and how to educate patients about medication-specific risks. Of particular interest in this discussion is the risk of PML in association with the recently approved B cell depleting therapy, ocrelizumab, particularly when switching from natalizumab. The risk of infection in association with MS treatments has become one of the most important factors in the choice of therapy. Balance of the overall risk versus benefit should be continuously re-evaluated during treatment.
Entities:
Keywords:
Central nervous system opportunistic infections; Fingolimod; Multiple sclerosis disease-modifying therapy; Natalizumab; Ocrelizumab; Progressive multifocal leukoencephalopathy
Authors: Ann M Arvin; Jerry S Wolinsky; Ludwig Kappos; Michele I Morris; Anthony T Reder; Carlo Tornatore; Anne Gershon; Michael Gershon; Myron J Levin; Mauritz Bezuidenhoudt; Norman Putzki Journal: JAMA Neurol Date: 2015-01 Impact factor: 18.302
Authors: Luca Durelli; Laura Conti; Marinella Clerico; Daniela Boselli; Giulia Contessa; Paolo Ripellino; Bruno Ferrero; Pierre Eid; Francesco Novelli Journal: Ann Neurol Date: 2009-05 Impact factor: 10.422
Authors: Robert J Fox; Andrew Chan; Ralf Gold; J Theodore Phillips; Krzysztof Selmaj; Ih Chang; Mark Novas; Jitesh Rana; Jing L Marantz Journal: Neurol Clin Pract Date: 2016-06
Authors: Gustavo Luna; Peter Alping; Joachim Burman; Katharina Fink; Anna Fogdell-Hahn; Martin Gunnarsson; Jan Hillert; Annette Langer-Gould; Jan Lycke; Petra Nilsson; Jonatan Salzer; Anders Svenningsson; Magnus Vrethem; Tomas Olsson; Fredrik Piehl; Thomas Frisell Journal: JAMA Neurol Date: 2020-02-01 Impact factor: 18.302
Authors: Roberta Amoriello; Victor Greiff; Alessandra Aldinucci; Elena Bonechi; Alberto Carnasciali; Benedetta Peruzzi; Anna Maria Repice; Alice Mariottini; Riccardo Saccardi; Benedetta Mazzanti; Luca Massacesi; Clara Ballerini Journal: Front Immunol Date: 2020-04-09 Impact factor: 7.561