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Infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society
C Papeix1, C Donze2, C Lebrun-Frénay3
1Département de neurologie, CRCSEP-Paris, Sorbonne Université, Hôpital de la Pitié salpêtrière, AP-HP 6, Paris 75013, France.
Introduction:
Viral, bacterial, or fungal infections are suspected of triggering multiple sclerosis (MS) and promoting relapses of the disease and are likely to be promoted by immune-active treatments. This raises questions about the infectious workup and preventive treatment of these infections prior to their initiation.
Objectives:
To establish recommendations on infections and MS. Provide information to patients and healthcare professionals on the minimal infectious workup to be performed in an MS patient at diagnosis and prior to initiation of immuno-active therapy in MS.
Methods:
The recommendation attempts to answer four main questions about infections and MS. The French Group for Recommendations in Multiple Sclerosis (France4MS) did a systematic review of articles from PubMed and universities databases (from January 1975 to June 2020), using the RAND/UCLA formalized consensus method. The RAND/UCLA method has been developed to synthesize the scientific literature and expert opinions on health care topics and was used for reaching a formal agreement. Twenty-three experts contributed to the detailed review and a group of 63 multidisciplinary health professionals validated the final version of 36 recommendations.
Results:
It is recommended that MS patients undergo a minimal infectious workup, check their vaccination status at diagnosis, and repeat it during follow-up and before starting immunotherapy. Screening and preventive treatment of viral (group Herpes virus, HPV, JCV, HCV, HBV), bacterial (mycobacteria) and fungal (Cryptococcus) infections is recommended prior to the initiation of certain immuno-active MS therapies.
Discussion And Conclusions:
At diagnosis of MS and prior to the choice of therapeutic strategy, it is recommended to update the vaccination schedule of MS patients in reference to the HCSP vaccination schedule and the SFSEP recommendations. Before starting immunosuppressive treatment, it is recommended to inform patients of the risks of infections and to look for a constitutive or acquired immune deficiency. Health professionals and patients should be informed of the updated recommendations on infections and MS.
Insights
Infections may trigger multiple sclerosis (MS) and its relapses. Updated infectious workup and vaccination are recommended for MS patients before and during treatment to prevent complications.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Infections are suspected triggers and promoters of multiple sclerosis (MS) relapses.
- Immune-active treatments for MS may exacerbate infections.
- This necessitates clear guidelines for infectious workup and prevention in MS patients.
Purpose of the Study:
- To establish evidence-based recommendations for managing infections in multiple sclerosis (MS).
- To provide guidance on essential infectious workup for MS patients at diagnosis and before immunotherapy initiation.
- To inform patients and healthcare professionals about infection risks and management strategies.
Main Methods:
- Systematic literature review of PubMed and university databases (1975-2020).
- Application of the RAND/UCLA formalized consensus method involving 23 experts.
- Validation of 36 recommendations by a multidisciplinary group of 63 health professionals.
Main Results:
- Minimal infectious workup, including vaccination status assessment, is recommended at MS diagnosis and during follow-up.
- Screening and preventive treatment for viral (e.g., Herpes virus, HPV, JCV, HCV, HBV), bacterial (mycobacteria), and fungal (Cryptococcus) infections are advised before specific immunotherapies.
- Vaccination schedules should be updated according to national guidelines.
Conclusions:
- Updating vaccination schedules is crucial at MS diagnosis and before therapeutic strategy selection.
- Informing patients about infection risks and screening for immune deficiencies are vital before immunosuppressive treatment.
- Dissemination of updated recommendations on infections and MS to professionals and patients is essential.
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