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Related Concept Videos

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Related Experiment Video

Updated: Jul 14, 2025

Induction and Diverse Assessment Indicators of Experimental Autoimmune Encephalomyelitis
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Multiple Sclerosis, Disease-Modifying Therapies, and Infections.

Annette M Langer-Gould1, Jessica B Smith2, Edlin G Gonzales2

  • 1From the Department of Neurology (A.M.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group; Department of Research and Evaluation (J.B.S., E.G.G., B.H.L.), Southern California Permanente Medical Group, Pasadena; and Department of Clinical Neuroscience (F.P.), Karolinska Institute, Stockholm, Sweden. annette.m.langer-gould@kp.org.

Neurology(R) Neuroimmunology & Neuroinflammation
|October 9, 2023
PubMed
Summary
This summary is machine-generated.

Patients with multiple sclerosis (MS) face higher infection risks, with certain disease-modifying therapies (DMTs) like rituximab and fingolimod increasing outpatient infection risk. Serious infection risks were elevated with rituximab and natalizumab compared to interferon-beta/glatiramer acetate.

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Area of Science:

  • Neurology
  • Infectious Disease Epidemiology
  • Pharmacovigilance

Background:

  • Increasing use of highly effective multiple sclerosis (MS) disease-modifying therapies (DMTs).
  • Limited understanding of real-world infection risks associated with various MS DMTs.
  • Need to differentiate risks attributable to DMTs versus MS itself or other factors.

Purpose of the Study:

  • To compare the real-world risk of outpatient and serious infections across different MS DMTs.
  • To assess whether infection risks are linked to specific DMTs, the presence of MS, or other patient factors.

Main Methods:

  • Retrospective cohort study utilizing electronic health records from Kaiser Permanente Southern California (2008-2020).
  • Inclusion of MS patients and matched non-MS controls.
  • Analysis of MS treatments, outpatient and serious infections, and covariates using Cox and Poisson regression.

Main Results:

  • Patients with MS exhibited higher risks of both outpatient and serious infections compared to controls.
  • Specific DMTs showed varying infection risks: Rituximab and fingolimod increased outpatient infection risk, while rituximab and natalizumab increased serious infection risk compared to interferon-beta/glatiramer acetate (IFN/GLAT).
  • Fingolimod was uniquely associated with outpatient herpetic infections; comorbidities and prior hospitalizations independently raised serious infection risk.

Conclusions:

  • Patients with MS have an elevated risk of infections, influenced by specific DMTs.
  • Risk mitigation strategies include optimizing bladder care, managing comorbidities, vaccination, and careful consideration of DMTs in high-risk patients.
  • Findings highlight the need for personalized risk assessment when selecting MS DMTs.