Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

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).

References

    1. Gold R, Rieckmann P, Chang P, Abdalla J. The long-term safety and tolerability of high-dose interferon beta-1a in relapsing-remitting multiple sclerosis: 4-year data from the PRISMS study. Eur J Neurol. 2005;12(8):649–656. doi: 10.1111/j.1468-1331.2005.01083.x. - DOI - PubMed
    1. Ford C, Goodman AD, Johnson K, Kachuck N, Lindsey JW, Lisak R, Luzzio C, Myers L, Panitch H, Preiningerova J, Pruitt A, Rose J, Rus H, Wolinsky J. Continuous long-term immunomodulatory therapy in relapsing multiple sclerosis: results from the 15-year analysis of the US prospective open-label study of glatiramer acetate. Mult Scler. 2010;16(3):342–350. doi: 10.1177/1352458509358088. - DOI - PMC - PubMed
    1. • Otero-Romero S, Sánchez-Montalvá A, Vidal-Jordana A. Assessing and mitigating risk of infection in patients with multiple sclerosis on disease modifying treatment. Expert Rev Clin Immunol. 2021:null-null. 10.1080/1744666X.2021.1886924. A thorough review examining the infectious risks associated with DMT use. - PubMed
    1. Ancau M, Berthele A, Hemmer B. CD20 monoclonal antibodies for the treatment of multiple sclerosis: up-to-date. Expert Opin Biol Ther. 2019;19(8):829–843. doi: 10.1080/14712598.2019.1611778. - DOI - PubMed
    1. Polman CH, O'Connor PW, Havrdova E, Hutchinson M, Kappos L, Miller DH, Phillips JT, Lublin FD, Giovannoni G, Wajgt A, Toal M, Lynn F, Panzara MA, Sandrock AW. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354(9):899–910. doi: 10.1056/NEJMoa044397. - DOI - PubMed

Substances