Multiple sclerosis treatment and infectious issues: update 2013

Winkelmann, Alexander; Loebermann, Micha; Reisinger, Emil C.; Zettl, Uwe K.

doi:10.1111/cei.12226

Cited by 33 publications

(32 citation statements)

References 122 publications

(161 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The risk of infection has been reported to increase due to the immunosuppressive therapies used by patients with MS, 16 although the magnitude of this increase is up for debate. Montgomery et al 6 did not control for therapy in their study; however, they suggest, based on the temporal variation of risk over 37 years of data, that therapy did not greatly influence their results.…”

Section: Discussionmentioning

confidence: 99%

Multiple Sclerosis and Risk of Infection-Related Hospitalization and Death in US Veterans

Nelson¹,

Xie²,

DuVall³

et al. 2015

International Journal of MS Care

View full text Add to dashboard Cite

Background: This study estimated the risk of infection-related hospitalizations and death in patients with and without multiple sclerosis (MS). Methods: We identified adults with MS in the US Department of Veterans Affairs (VA) system between 1999 and 2010. Each veteran with MS was matched, on age and sex, with up to four veterans without MS. Multivariable Cox proportional hazards regression models were performed to assess the influence of MS on the development of serious and fatal infections. Results: The cohort included 7743 veterans with MS and 30,972 veterans without MS. Mean (SD) age was 53.8 (13.3) years, and 80.8% were male. The incidence per 1000 person-years of overall serious infections was 19.2 (95% confidence interval [CI], 17.6–20.8) for those with MS and 10.3 (95% CI, 9.8–10.9) for those without MS. Fatal infection incidence rates were 1.2 (95% CI, 0.8–1.7) for patients with MS and 0.5 (95% CI, 0.3–0.6) for patients without MS. Regression models showed that veterans with MS were at greater risk for overall serious (hazard ratio [HR] = 1.52, P < .01) and fatal (HR = 1.85, P = .03) infections and serious respiratory (HR = 1.31, P = .01), urinary tract (HR = 4.44, P < .01), and sepsis-related infections (HR = 2.56, P < .01). Conclusions: This study provides evidence that VA patients with MS are more likely than those without MS to be hospitalized and die of infection.

show abstract

Section: Discussionmentioning

confidence: 99%

Multiple Sclerosis and Risk of Infection-Related Hospitalization and Death in US Veterans

Nelson¹,

Xie²,

DuVall³

et al. 2015

International Journal of MS Care

View full text Add to dashboard Cite

show abstract

“…IFN-b is involved in the immune response to viral infections and is upregulated during the course of viral illness. The precise mechanisms by which IFN-b-1b (including Betaseron Ò and Extavia Ò ) and the related compounds IFN-b-1a (Avonex Ò , Rebif Ò , and Plegridy TM ) affect the immune system and MS remains uncertain; however, research shows that these compounds may inhibit T-cell proliferation, increase suppressor T-cell activity, inhibit proinflammatory cytokines such as TNFa and IFNc, induce immunomodulatory cytokines IL-10 and TGFb, reduce expression of human leukocyte antigen (HLA) class II and adhesion molecules, block metalloproteinases and chemokines, and/or reduce BBB permeability [45]. Despite possible development of leukocytopenia, abundant data from clinical trials and postmarketing experience indicate that severe infection associated with the use of these agents is exceedingly rare.…”

Section: Interferon (Ifn)-bmentioning

confidence: 99%

Infection Risk in Patients on Multiple Sclerosis Therapeutics

Williamson

Berger

2015

CNS Drugs

View full text Add to dashboard Cite

The interface of multiple sclerosis (MS) and infection occurs on several levels. First, infectious disease has been postulated as a potential trigger, if not cause, of MS. Second, exacerbation of MS has been well-documented as a consequence of infection, and, lastly, infectious diseases have been recognized as a complication of the therapies currently employed in the treatment of MS. MS is a disease in which immune dysregulation is a key component. Examination of central nervous system (CNS) tissue of people affected by MS demonstrates immune cell infiltration, activation and inflammation. Therapies that alter the immune response have demonstrated efficacy in reducing relapse rates and evidence of brain inflammation on magnetic resonance imaging (MRI). Despite the altered immune response in MS, there is a lack of evidence that these patients are at increased risk of infectious disease in the absence of treatment or debility. Links between infections and disease-modifying therapies (DMTs) used in MS will be discussed in this review, as well as estimates of occurrence and ways to potentially minimize these risks. We address infection in MS in a comprehensive fashion, including (1) the impact of infections on relapse rates in patients with MS; (2) a review of available infection data from pivotal trials and postmarketing studies for the approved and experimental DMTs, including frequency, types and severity of infections; and (3) relevant risk minimization strategies, particularly as they pertain to progressive multifocal leukoencephalopathy (PML).

show abstract

“…Adverse effects, frequent: secondary amenorrhoea/ azoospermia, nausea and vomiting, myelosuppression; infrequent: alopecia, cardiotoxicity, secondary leukaemia (especially AML) [45,46].…”

Section: Established Intravenous Immunosuppressive Drugs: Mitoxantronmentioning

confidence: 99%

“…an opportunistic infection of the CNS with the JC-virus that leads eventually to death (approximately 20%) or severe neurological sequelae [45,46]. Risk of PML increases with long treatment duration (>2 years), preceding immunosuppressive treatment (independent from its duration and strength as well as the time interval to the natalizumab treatment), or a positive serological status for JC-virus [62].…”

Section: Natalizumab and Firategrastmentioning

confidence: 99%

Disease-modifying therapy in multiple sclerosis and chronic inflammatory demyelinating polyradiculoneuropathy: common and divergent current and future strategies

Melzer

Meuth

2014

Clin Exp Immunol

View full text Add to dashboard Cite

OTHER ARTICLES PUBLISHED IN THIS SERIESParaneoplastic neurological syndromes. Clinical and Experimental Immunology 2014, 175: 336-48. Diagnosis, pathogenesis and treatment of myositis: recent advances. Clinical and Experimental Immunology 2014, 175: 349-58. Monoclonal antibodies in treatment of multiple sclerosis. Clinical and Experimental Immunology 2014, 175: 373-84 SummaryMultiple sclerosis (MS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) represent chronic, autoimmune demyelinating disorders of the central and peripheral nervous system. Although both disorders share some fundamental pathogenic elements, treatments do not provide uniform effects across both disorders. We aim at providing an overview of current and future disease-modifying strategies in these disorders to demonstrate communalities and distinctions.

show abstract

Multiple sclerosis treatment and infectious issues: update 2013

Cited by 33 publications

References 122 publications

Multiple Sclerosis and Risk of Infection-Related Hospitalization and Death in US Veterans

Multiple Sclerosis and Risk of Infection-Related Hospitalization and Death in US Veterans

Infection Risk in Patients on Multiple Sclerosis Therapeutics

Disease-modifying therapy in multiple sclerosis and chronic inflammatory demyelinating polyradiculoneuropathy: common and divergent current and future strategies

Contact Info

Product

Resources

About