Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies

PURPOSE OF REVIEW: The newer, higher-efficacy disease-modifying therapies (DMTs) for multiple sclerosis (MS)—orals and monoclonals—have more profound immunomodulatory and immunosuppressive properties than the older, injectable therapies and require risk mitigation strategies to reduce the risk of se...

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Autores principales: Smith, Tyler Ellis, Kister, Ilya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2021
Materias:
Neurology of Systemic Diseases (J. Biller, Section Editor)
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132488/
https://www.ncbi.nlm.nih.gov/pubmed/34009478
http://dx.doi.org/10.1007/s11910-021-01117-y
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author Smith, Tyler Ellis
Kister, Ilya
author_facet Smith, Tyler Ellis
Kister, Ilya
author_sort Smith, Tyler Ellis
collection PubMed
description PURPOSE OF REVIEW: The newer, higher-efficacy disease-modifying therapies (DMTs) for multiple sclerosis (MS)—orals and monoclonals—have more profound immunomodulatory and immunosuppressive properties than the older, injectable therapies and require risk mitigation strategies to reduce the risk of serious infections. This review will provide a systematic framework for infectious risk mitigation strategies relevant to these therapies. RECENT FINDINGS: We classify risk mitigation strategies according to the following framework: (1) screening and patient selection, (2) vaccinations, (3) antibiotic prophylaxis, (4) laboratory and MRI monitoring, (5) adjusting dose and frequency of DMT, and (6) behavioral modifications to limit the risk of infection. We systematically apply this framework to the infections for which risk mitigations are available: hepatitis B, herpetic infections, progressive multifocal leukoencephalopathy, and tuberculosis. We also discuss up-to-date recommendations regarding COVID-19 vaccinations for patients on DMTs. SUMMARY: We offer a practical, comprehensive, DMT-specific framework of derisking strategies designed to minimize the risk of infections associated with the newer MS therapies.
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spelling pubmed-81324882021-05-19 Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies Smith, Tyler Ellis Kister, Ilya Curr Neurol Neurosci Rep Neurology of Systemic Diseases (J. Biller, Section Editor) PURPOSE OF REVIEW: The newer, higher-efficacy disease-modifying therapies (DMTs) for multiple sclerosis (MS)—orals and monoclonals—have more profound immunomodulatory and immunosuppressive properties than the older, injectable therapies and require risk mitigation strategies to reduce the risk of serious infections. This review will provide a systematic framework for infectious risk mitigation strategies relevant to these therapies. RECENT FINDINGS: We classify risk mitigation strategies according to the following framework: (1) screening and patient selection, (2) vaccinations, (3) antibiotic prophylaxis, (4) laboratory and MRI monitoring, (5) adjusting dose and frequency of DMT, and (6) behavioral modifications to limit the risk of infection. We systematically apply this framework to the infections for which risk mitigations are available: hepatitis B, herpetic infections, progressive multifocal leukoencephalopathy, and tuberculosis. We also discuss up-to-date recommendations regarding COVID-19 vaccinations for patients on DMTs. SUMMARY: We offer a practical, comprehensive, DMT-specific framework of derisking strategies designed to minimize the risk of infections associated with the newer MS therapies. Springer US 2021-05-19 2021 /pmc/articles/PMC8132488/ /pubmed/34009478 http://dx.doi.org/10.1007/s11910-021-01117-y Text en © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Neurology of Systemic Diseases (J. Biller, Section Editor)
Smith, Tyler Ellis
Kister, Ilya
Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies
title Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies
title_full Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies
title_fullStr Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies
title_full_unstemmed Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies
title_short Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies
title_sort infection mitigation strategies for multiple sclerosis patients on oral and monoclonal disease-modifying therapies
topic Neurology of Systemic Diseases (J. Biller, Section Editor)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132488/
https://www.ncbi.nlm.nih.gov/pubmed/34009478
http://dx.doi.org/10.1007/s11910-021-01117-y
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