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Review
. 2021 May 19;21(7):36.
doi: 10.1007/s11910-021-01117-y.

Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies

Tyler Ellis Smith  1   2 , Ilya Kister  3
Affiliations
Review

Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies

Tyler Ellis Smith et al. Curr Neurol Neurosci Rep. .

Abstract

Purpose of review: The newer, higher-efficacy disease-modifying therapies (DMTs) for multiple sclerosis (MS)-orals and monoclonals-have more profound immunomodulatory and immunosuppressive properties than the older, injectable therapies and require risk mitigation strategies to reduce the risk of serious infections. This review will provide a systematic framework for infectious risk mitigation strategies relevant to these therapies.

Recent findings: We classify risk mitigation strategies according to the following framework: (1) screening and patient selection, (2) vaccinations, (3) antibiotic prophylaxis, (4) laboratory and MRI monitoring, (5) adjusting dose and frequency of DMT, and (6) behavioral modifications to limit the risk of infection. We systematically apply this framework to the infections for which risk mitigations are available: hepatitis B, herpetic infections, progressive multifocal leukoencephalopathy, and tuberculosis. We also discuss up-to-date recommendations regarding COVID-19 vaccinations for patients on DMTs. We offer a practical, comprehensive, DMT-specific framework of derisking strategies designed to minimize the risk of infections associated with the newer MS therapies.

Keywords: Adverse events; Disease-modifying therapy; Infections; Multiple sclerosis; Risk mitigation; Treatment.

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Conflict of interest statement

TES received fellowship in part by the National Multiple Sclerosis Society Clinical Care Physician Fellowship 2020–2021. TES received honoraria from the American Academy of Neurology in 2020.

IK served on the scientific advisory board for Biogen Idec, Genentech, Alexion, EMDSerono; received consulting fees from Roche; and received research support from Guthy-Jackson Charitable Foundation, National Multiple Sclerosis Society, Biogen Idec, Serono, Genzyme, and Genentech/Roche; he receives royalties from Wolters Kluwer for ‘Top 100 Diagnosis in Neurology’ (co-written with Jose Biller).

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