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The risk of infection in patients with multiple sclerosis treated with disease-modifying therapies: A Delphi
Lucia Moiola1, Valeria Barcella2, Simone Benatti3
1Multiple Sclerosis Center and Neurology Department, IRCCS Ospedale San Raffaele, Milan, Italy.
Abstract:
The risk of infection associated with immunomodulatory or immunosuppressive disease-modifying drugs (DMDs) in patients with multiple sclerosis (MS) has been increasingly addressed in recent scientific literature. A modified Delphi consensus process was conducted to develop clinically relevant, evidence-based recommendations to assist physicians with decision-making in relation to the risks of a wide range of infections associated with different DMDs in patients with MS. The current consensus statements, developed by a panel of experts (neurologists, infectious disease specialists, a gynaecologist and a neuroradiologist), address the risk of iatrogenic infections (opportunistic infections, including herpes and cryptococcal infections, candidiasis and listeria; progressive multifocal leukoencephalopathy; human papillomavirus and urinary tract infections; respiratory tract infections and tuberculosis; hepatitis and gastrointestinal infections) in patients with MS treated with different DMDs, as well as prevention strategies and surveillance strategies for the early identification of infections. In the discussion, more recent data emerged in the literature were taken into consideration. Recommended risk reduction and management strategies for infections include screening at diagnosis and before starting a new DMD, prophylaxis where appropriate, monitoring and early diagnosis.
Insights
Physicians can now access evidence-based recommendations for managing infection risks in multiple sclerosis (MS) patients taking disease-modifying drugs (DMDs). These guidelines help reduce and monitor infections, ensuring safer MS treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Multiple sclerosis (MS) treatment often involves immunomodulatory or immunosuppressive disease-modifying drugs (DMDs).
- These DMDs can increase the risk of various infections in MS patients.
- Managing these infection risks is crucial for patient safety and treatment efficacy.
Purpose of the Study:
- To develop clinically relevant, evidence-based recommendations for managing infection risks in MS patients treated with DMDs.
- To provide guidance on decision-making for physicians regarding infection risks associated with different DMDs.
- To establish prevention and surveillance strategies for early infection detection.
Main Methods:
- A modified Delphi consensus process involving a multidisciplinary expert panel (neurologists, infectious disease specialists, etc.).
- Review of recent scientific literature on infections in MS patients treated with DMDs.
- Development of consensus statements addressing specific infection risks and management strategies.
Main Results:
- Consensus statements were developed covering a wide range of iatrogenic infections (e.g., opportunistic infections, PML, HPV, UTIs, RTIs, hepatitis).
- Recommendations include screening before and during DMD treatment, appropriate prophylaxis, and continuous monitoring.
- Strategies for early identification and management of infections were outlined.
Conclusions:
- The developed recommendations provide a framework for physicians to manage infection risks in MS patients on DMDs.
- Proactive screening, prophylaxis, monitoring, and early diagnosis are key to reducing infection-related complications.
- These guidelines aim to optimize the safety and effectiveness of DMD therapy in multiple sclerosis.
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