Related Experiment Video
Updated: Apr 16, 2026
Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination
Published on: September 12, 2016
Infection risk in patients on multiple sclerosis therapeutics
Eric M Williamson1, Joseph R Berger
1Division of Multiple Sclerosis, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 3 Gates Building, Philadelphia, PA, 19104, USA, ericwilliamsonmd@gmail.com.
Abstract:
The interface of multiple sclerosis (MS) and infection occurs on several levels. First, infectious disease has been postulated as a potential trigger, if not cause, of MS. Second, exacerbation of MS has been well-documented as a consequence of infection, and, lastly, infectious diseases have been recognized as a complication of the therapies currently employed in the treatment of MS. MS is a disease in which immune dysregulation is a key component. Examination of central nervous system (CNS) tissue of people affected by MS demonstrates immune cell infiltration, activation and inflammation. Therapies that alter the immune response have demonstrated efficacy in reducing relapse rates and evidence of brain inflammation on magnetic resonance imaging (MRI). Despite the altered immune response in MS, there is a lack of evidence that these patients are at increased risk of infectious disease in the absence of treatment or debility. Links between infections and disease-modifying therapies (DMTs) used in MS will be discussed in this review, as well as estimates of occurrence and ways to potentially minimize these risks. We address infection in MS in a comprehensive fashion, including (1) the impact of infections on relapse rates in patients with MS; (2) a review of available infection data from pivotal trials and postmarketing studies for the approved and experimental DMTs, including frequency, types and severity of infections; and (3) relevant risk minimization strategies, particularly as they pertain to progressive multifocal leukoencephalopathy (PML).
Insights
Infections can trigger, worsen, or complicate multiple sclerosis (MS) treatments. This review examines infection risks with MS therapies, focusing on minimizing complications like progressive multifocal leukoencephalopathy (PML).
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Multiple sclerosis (MS) involves immune dysregulation, with CNS inflammation and immune cell infiltration.
- Infections are linked to MS as potential triggers, exacerbating factors, and complications of MS therapies.
- While MS alters immune responses, patients may not face higher infection risk without treatment or debility.
Purpose of the Study:
- To comprehensively review the multifaceted relationship between infections and multiple sclerosis (MS).
- To analyze the impact of infections on MS relapse rates.
- To evaluate infection data associated with disease-modifying therapies (DMTs) and discuss risk mitigation, including for progressive multifocal leukoencephalopathy (PML).
Main Methods:
- Review of infection data from pivotal trials and postmarketing studies of approved and experimental MS DMTs.
- Analysis of infection frequency, types, and severity in relation to MS treatments.
- Examination of risk minimization strategies for infections in MS patients, particularly concerning PML.
Main Results:
- Infections can exacerbate MS and are recognized complications of MS therapies.
- Data from clinical trials and postmarketing studies provide insights into infection risks associated with various DMTs.
- Specific risks, such as progressive multifocal leukoencephalopathy (PML), require targeted risk minimization strategies.
Conclusions:
- Understanding the interplay between infections and MS is crucial for patient management.
- Careful monitoring and risk mitigation strategies are essential when using DMTs in MS patients.
- Minimizing infection risks, especially PML, is a key aspect of optimizing MS treatment outcomes.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:25Clinical Significance of Antibiotic Resistance
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:17Transmission-based Precautions I: Contact, Enteric, and Droplets
Contact Precautions:
Contact precautions are the measures taken to prevent the transmission of infectious agents, especially epidemiologically important microorganisms such as MRSA or influenza, primarily transmitted through direct or indirect contact with an...
01:20Infection
The chain begins with pathogens: bacteria, viruses, fungi, prions, or parasites such as protozoa helminths. These can be present on the skin as transient or resident flora, or they can be acquired from the environment. Identifying and treating the type of infection and...