The risk of infection in patients with multiple sclerosis treated with disease-modifying therapies: A Delphi consensus statement

Abstract

The risk of infection associated with immunomodulatory or immunosuppressive disease-modifying drugs (DMDs) in patients with multiple sclerosis (MS) has been increasingly addressed in recent scientific literature. A modified Delphi consensus process was conducted to develop clinically relevant, evidence-based recommendations to assist physicians with decision-making in relation to the risks of a wide range of infections associated with different DMDs in patients with MS. The current consensus statements, developed by a panel of experts (neurologists, infectious disease specialists, a gynaecologist and a neuroradiologist), address the risk of iatrogenic infections (opportunistic infections, including herpes and cryptococcal infections, candidiasis and listeria; progressive multifocal leukoencephalopathy; human papillomavirus and urinary tract infections; respiratory tract infections and tuberculosis; hepatitis and gastrointestinal infections) in patients with MS treated with different DMDs, as well as prevention strategies and surveillance strategies for the early identification of infections. In the discussion, more recent data emerged in the literature were taken into consideration. Recommended risk reduction and management strategies for infections include screening at diagnosis and before starting a new DMD, prophylaxis where appropriate, monitoring and early diagnosis.

Serological response to SARS-CoV-2 vaccination in multiple sclerosis patients treated with fingolimod or ocrelizumab: an initial real-life experience

“…Inactivated vaccines are generally safe in MS, with the majority of data deriving from previous experiences with flu vaccines [ 5 ]. Despite specific information is not yet fully available from clinical trials, no specific safety concerns have emerged for both mRNA and viral vector SARS-CoV-2 vaccines in MS patients [ 6 , 7 ].…”

COVID-19 mRNA vaccines (Pfizer-BioNTech and Moderna) in patients with multiple sclerosis: a statement by a working group convened by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society

“…However, some of the disease modifying therapies (DMTs) used for MS could hamper the immune response necessary for developing immunity against SARS-CoV-2 [7][8][9][10]. As with any other vaccine, in MS patients each decision needs to be taken individually after a thorough consideration of the potential risks and benefits [11][12][13][14][15][16].…”

Ocrelizumab for the Treatment of Multiple Sclerosis: Safety, Efficacy, and Pharmacology

“…A strict monitoring to detect infections during treatment is just as important to consider. 73 A screening before starting ocrelizumab is reported in Table 1 . Post-marketing-surveillance initiatives and pharmacovigilance studies will be essential to determinate the safety of the use of ocrelizumab.…”