Author Of 1 Presentation
P0486 - Rate of latent infections and vaccination in a cohort of Multiple Sclerosis patients assessed for disease modifying therapies. (ID 1837)
Abstract
Background
Disease modifying therapies (DMT) for treatment of multiple sclerosis (MS) have potent and variable effects on the immune system. This immunomodulation exposes MS patients to new infections, reactivation of latent pathogens and can worsen chronic infections. At the same time the urgency of early DMT treatment in order to improve prognosis call for a more proactive approach in testing for latent infections and appropriate vaccinations as soon as the diagnosis of MS. We performed a retrospective study to evaluate our local screening and looked to see how screening could affect initiation or escalation of DMT.
Objectives
We sought to investigate the rate of latent infections and vaccinations in all MS patients considered for a DMT at the MS centre at Brighton and Sussex University Hospital from November 2018 to January 2020.
Methods
All patients who were considered for a DMT and had all their pre-screening done were included. The pre-screening for patients considered for a DMT is standardised and that includes the screening for HIV, syphilis, hepatitis B and C, VZV, MMR vaccination and latent tuberculosis (TB) using interferon gamma release assay (IGRA). DMT medication use was recorded at time screening was performed
Results
159 MS patients were screened; 115 (72.3 %) were females; mean age 44.5 ± 10.5. Ten patients (6.3%) were IGRA positive; out of this group, 20% had likely false negatives tests while on steroids as repeat samples off steroids within weeks tested positive; 20% were known to have had latent TB before and were treated with anti-TB medications; 30% were already on a DMT at time of testing (n=1 glatiramer acetate and n=2 dimethyl fumarate). One patient whilst not on any DMT at the time of testing, had been previously on two beta-interferon preparations and dimethyl fumarate. All patients, apart from those previously been treated, received anti-TB therapy prior to starting a DMT. One patient suffered liver toxicity due to the anti-TB treatment. A minimum 3 monthsanti-TB treatment course was completed prior to starting a new DMT. None of the patients tested positive for HIV, syphilis or hepatitis B or C. Only 11% of patients were previously immunised against hepatitis B reflecting the non-mandatory policy in UK for most professions. Two (1.3%) patients required VZV immunisation and 12 (7.5%) patients required repeat MMR vaccination.
Conclusions
This study suggests that infections, in particular latent TB, and lack of vaccination is not uncommon amongst MS patients. The need for treatment of such infections and vaccination would invariable delay DMT treatment start hence actively screening MS patients at the time of diagnosis would be highly recommended.
Presenter Of 1 Presentation
P0486 - Rate of latent infections and vaccination in a cohort of Multiple Sclerosis patients assessed for disease modifying therapies. (ID 1837)
Abstract
Background
Disease modifying therapies (DMT) for treatment of multiple sclerosis (MS) have potent and variable effects on the immune system. This immunomodulation exposes MS patients to new infections, reactivation of latent pathogens and can worsen chronic infections. At the same time the urgency of early DMT treatment in order to improve prognosis call for a more proactive approach in testing for latent infections and appropriate vaccinations as soon as the diagnosis of MS. We performed a retrospective study to evaluate our local screening and looked to see how screening could affect initiation or escalation of DMT.
Objectives
We sought to investigate the rate of latent infections and vaccinations in all MS patients considered for a DMT at the MS centre at Brighton and Sussex University Hospital from November 2018 to January 2020.
Methods
All patients who were considered for a DMT and had all their pre-screening done were included. The pre-screening for patients considered for a DMT is standardised and that includes the screening for HIV, syphilis, hepatitis B and C, VZV, MMR vaccination and latent tuberculosis (TB) using interferon gamma release assay (IGRA). DMT medication use was recorded at time screening was performed
Results
159 MS patients were screened; 115 (72.3 %) were females; mean age 44.5 ± 10.5. Ten patients (6.3%) were IGRA positive; out of this group, 20% had likely false negatives tests while on steroids as repeat samples off steroids within weeks tested positive; 20% were known to have had latent TB before and were treated with anti-TB medications; 30% were already on a DMT at time of testing (n=1 glatiramer acetate and n=2 dimethyl fumarate). One patient whilst not on any DMT at the time of testing, had been previously on two beta-interferon preparations and dimethyl fumarate. All patients, apart from those previously been treated, received anti-TB therapy prior to starting a DMT. One patient suffered liver toxicity due to the anti-TB treatment. A minimum 3 monthsanti-TB treatment course was completed prior to starting a new DMT. None of the patients tested positive for HIV, syphilis or hepatitis B or C. Only 11% of patients were previously immunised against hepatitis B reflecting the non-mandatory policy in UK for most professions. Two (1.3%) patients required VZV immunisation and 12 (7.5%) patients required repeat MMR vaccination.
Conclusions
This study suggests that infections, in particular latent TB, and lack of vaccination is not uncommon amongst MS patients. The need for treatment of such infections and vaccination would invariable delay DMT treatment start hence actively screening MS patients at the time of diagnosis would be highly recommended.