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.
Infectious risk in multiple sclerosis patients treated with disease-modifying therapies: A three-year observational cohort study / Zingaropoli, M. A.; Pasculli, P.; Iannetta, M.; Perri, V.; Tartaglia, M.; Crisafulli, S. G.; Merluzzo, C.; Baione, V.; Mazzochi, L.; Taglietti, A.; Pauri, F.; Frontoni, M.; Altieri, M.; Gaeta, A.; Antonelli, G.; Conte, A.; Mastroianni, C. M.; Ciardi, M. R.. - In: MULTIPLE SCLEROSIS JOURNAL, EXPERIMENTAL, TRANSLATIONAL AND CLINICAL. - ISSN 2055-2173. - 8:1(2022), p. 20552173211065731. [10.1177/20552173211065731]
Infectious risk in multiple sclerosis patients treated with disease-modifying therapies: A three-year observational cohort study
Zingaropoli M. A.
;Pasculli P.;Iannetta M.;Perri V.;Tartaglia M.;Crisafulli S. G.;Merluzzo C.;Baione V.;Taglietti A.;Pauri F.;Frontoni M.;Altieri M.;Gaeta A.;Antonelli G.;Conte A.;Mastroianni C. M.;Ciardi M. R.
2022
Abstract
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.| File | Dimensione | Formato | |
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