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. 2022 Oct;80(10):1057-1066.
doi: 10.1055/s-0042-1754348. Epub 2022 Oct 4.

Reducing infection risk in multiple sclerosis and neuromyelitis optica spectrum disorders: a Brazilian reference center's approach

Ana Beatriz Ayroza Galvão Ribeiro Gomes  1 , Lucas Bueno Feo  1 , Guilherme Diogo Silva  1 , Caio César Diniz Disserol  1 , Renata Barbosa Paolilo  1 , Amanda Nazareth Lara  2 , Adriana Coracini Tonácio  2 , Maria Fernanda Mendes  1   3 , Samira Luísa Apóstolos Pereira  1 , Dagoberto Callegaro  1
Affiliations

Reducing infection risk in multiple sclerosis and neuromyelitis optica spectrum disorders: a Brazilian reference center's approach

Ana Beatriz Ayroza Galvão Ribeiro Gomes et al. Arq Neuropsiquiatr. 2022 Oct.

Abstract
in English, Portuguese

Background: Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) are the most common autoimmune diseases of the central nervous system (CNS). They present chronic relapsing courses that demand treatment with disease-modifying drugs (DMDs) to prevent inflammatory activity. Disease-modifying drugs lead to immunomodulation or immunosuppression through diverse mechanisms (e.g., shifting lymphocyte and cytokine profile, suppressing specific lymphocyte subpopulations). Thus, patients are more prone to infectious complications and associated worsening of disease.

Objective: To present feasible strategies for mitigating the infection risk of MS and NMOSD treated patients.

Methods: Targeted literature review concerning the management of infection risk with an emphasis on vaccination, therapy-specific measures, and particularities of the Brazilian endemic infectious diseases' scenario.

Conclusion: We propose a vaccination schedule, infectious screening routine, and prophylactic measures based on the current scientific evidence. Awareness of emergent tropical diseases is necessary due to evidence of demyelinating events and possible parainfectious cases of MS and NMOSD.

Antecedentes: A esclerose múltipla (EM) e a doença do espectro neuromielite optica (NMOSD) são as doenças autoimunes mais comuns do sistema nervoso central (SNC). Ambas apresentam curso crônico com recaídas (surtos) e exigem tratamento com drogas modificadoras de doenças (DMDs) para a prevenção de atividade inflamatória. As DMDs levam à imunomodulação ou imunossupressão através de diversos mecanismos (por exemplo deslocando e/ou suprimindo subpopulações linfocitárias ou alterando perfil de produção de citocinas). Desta forma, os pacientes com EM ou NMOSD são mais propensos a complicações infecciosas, as quais podem levar ao agravamento de suas doenças de base.

Objetivo: Apresentar estratégias viáveis para mitigar o risco de infecção de pacientes com EM ou NMOSD sob tratamento. MéTODOS: Revisão bibliográfica focada em manejo de risco de infecção com ênfase em vacinação, medidas específicas de tratamento e particularidades de doenças infecciosas endêmicas do Brasil. CONCLUSãO: Propomos um calendário de vacinação, rotina de triagem infecciosa e medidas profiláticas baseadas em evidências científicas atuais. A conscientização das doenças tropicais emergentes é necessária devido a evidências de eventos desmielinizantes e possíveis casos parainfecciosos de EM e NMOSD.

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Conflict of interest statement

Samira Luisa Pereira Apóstolos, Maria Fernanda Mendes, and Dagoberto Callegaro have participated in lectures and developed written educational materials for Biogen, Roche, Merck, and Novartis.

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