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Interplay between age and disease-modifying treatments in influencing infection risk in multiple sclerosis

Sarah Lena Susanna Jacober1,2, Giulio Disanto1, Rosaria Sacco1

  • 1Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.

Multiple Sclerosis (Houndmills, Basingstoke, England)
|October 3, 2023
PubMed
Abstract

Insights

Disease-modifying therapies (DMTs) for multiple sclerosis (MS) increase infection risk, particularly monoclonal antibodies (MABs) and oral DMTs in younger patients. Higher disability predicts severe infections, irrespective of treatment.

Area of Science:

  • Neurology
  • Immunology
  • Infectious Disease

Background:

  • Disease-modifying treatments (DMTs) for multiple sclerosis (MS) can elevate infection risk.
  • Safety of immunosuppressive DMTs in older MS patients is uncertain due to trial exclusions.

Purpose of the Study:

  • To investigate the association between DMTs, aging, and other clinical factors with infection risk in MS patients.
  • To analyze infection incidence, type, and severity in relation to specific DMTs and patient demographics.

Main Methods:

  • Prospective observational study at a single MS center.
  • Inclusion of 503 MS patients categorized by treatment: injectables/untreated, oral DMTs, and monoclonal antibodies (MABs).
  • Statistical analysis using multivariable Poisson and Cox regressions to assess infection risk factors.

Main Results:

  • Monoclonal antibodies (MABs) and oral DMTs showed a significant positive association with infection incidence compared to injectables/untreated (IRR=2.32 and 1.95, respectively).
  • The infection risk associated with MABs was notably stronger in patients under 50 years old (IRR=5.90) than in older patients (IRR=1.95), after excluding COVID-19 cases.
  • Higher disability and male sex were identified as the sole predictors of severe infections.

Conclusions:

  • Treatment with MABs and oral DMTs correlates with an increased incidence of infections in MS patients.
  • Younger MS patients (<50 years) experience a more pronounced increase in infection risk with MAB treatment.
  • Patient disability level is the primary determinant of severe infection risk, independent of the specific DMT used.
Keywords:
Agedisease-modifying treatmentsinfection riskmultiple sclerosis

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