Centro Hospitalar e Universitário de Coimbra
Neurology

Author Of 1 Presentation

Observational Studies Poster Presentation

P0921 - The impact of Latent Tuberculosis in Multiple Sclerosis management: a cohort study from a tertiary Multiple Sclerosis centre   (ID 1714)

Speakers
Presentation Number
P0921
Presentation Topic
Observational Studies

Abstract

Background

Disease-modifying drugs (DMDs) may result in a high risk of opportunistic infections including progression of primary tuberculosis or reactivation of latent TB (LTB).

Objectives

The aim of this work is to characterize LTB in a population of patients with multiple sclerosis (MS) and to analyze its impact on MS management.

Methods

Retrospective study of MS patients who underwent QuantiFERON-TB Gold (QTF-G) in our centre between January 2015 and May 2019.

Results

Among 367 MS patients, QFT-G was negative in 323 (88%), positive in 35 (10%) and undetermined in 9 (2%). No cases of active infection were detected. Regarding patients with a positive QFT-G, the mean (SD) age was 49.1 (10.7) years, Expanded Disability Status Scale (EDSS) 3.1 (2.0), disease duration 9.7 (8.5) years, treatment duration 7.7 (7.0) years and number of previous DMDs 1.7 (2.1). Ten patients (28.6%) were DMD-naïve. Age, EDSS, disease duration, treatment duration and number of DMDs were not associated with positive QTF-G. All patients with a positive QTF-G were treated for LTB, 34 with isoniazid for 9 months and one with rifampin for 4 months. Two patients (5.7%) developed hepatic adverse effects, resolved after discontinuation of isoniazid, followed by a switch to a 4-month regimen of rifampin, which was started when liver enzymes returned to the normal range. Of the 35 patients with a positive QTF-G, 4 (11%) were started simultaneously on a DMD and LTB treatment regimen and in 31 (89%) there was a postponing of the start/switch of DMD (8 were DMD-naïve, 15 were kept on previous DMD and 8 suspended the previous DMD and were left temporarily without MS medication). The mean (SD) duration of the postponement was 3.4 (3.0) months. Four patients had relapses during the period waiting for the start/switch of DMD.

Conclusions

In our study, the treatment of LTB was effective and relatively safe. As 12.9% of patients had relapses while waiting for the start/switch of DMD, our work suggests that the start of DMDs should not be delayed beyond the 4-8 weeks recommended in the literature.

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