Sapienza University
Department of Public Health and Infectious Diseases

Author Of 1 Presentation

Disease Modifying Therapies – Risk Management Poster Presentation

P0354 - Management of infectious risk in multiple sclerosis: implication for screening, prophylaxis and therapies (ID 1839)

Speakers
Presentation Number
P0354
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

Background

The DMTs largely used in MS may result in higher risk of infectious complications. Screening for and treatment of latent tuberculosis infection (LTBI) should be considered for patients receiving alemtuzumab, teriflunomide, fingolimod and natalizumab. Hepatitis B virus (HBV) reactivation may be harmful mainly for ocrelizumab and alemtuzumab treated patients.

Objectives

Aim of the study was to define the infectious risk in DMTs-treated MS patients with approaches tailored to individual patients.

Methods

At the Neuroinfectious Unit of Policlinico Umberto I (Rome), before starting or switching to DMTs, MS patients were evaluated for infectious risk. HBV and Mycobacterium tuberculosis (MTB) were investigated by serological test as hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B core antibody (HBcAb), and by quantiFERON®-TB Gold In-Tube (QFT) assay, respectively. HBV-DNA detection was performed in chronic hepatitis B MS patients and monthly monitored during DMTs. In QFT positive patients, active tuberculosis (TB) was excluded by medical history and chest X-ray and when necessary, sputum smear microscopy, sputum culture and MTB PCR were also performed. All LTBI patients were undergone to TB prophylaxis (isoniazid+rifampicin) for 3 months. DMTs were started after one-month prophylaxis.

Results

One hundred thirty-eight MS patients (79 females, 59 males) with a median age [interquartile range (IQR)] of 47.5 (37-56), median years of disease (IQR) of 8 (2-18) and median EDSS (IQR) of 3.5 (2-6), were enrolled. Before starting DMTs, 10.1% (14/138) of patients had chronic B hepatitis and 10.1% (14/138) showed QFT positivity. During DMTs follow-up, one patient revealed HBV reactivation. The patient remained asymptomatic with liver enzymes unchanged. HBV-DNA became undetectable after 2 weeks of specific antiviral treatment without discontinuing ocrelizumab. Among QFT positive patients, no TB reactivation was observed. Interestingly, one of the QFT negative patients became positive during fingolimod treatment.

Conclusions

HBV and TB screening should be recommended in MS patients candidate for DMTs. HBV monitoring may avoid a fatal event and the choice of a preemptive strategy spares HBV prophylaxis when unnecessary. Beside preventing TB reactivation, TB prophylaxis based on two active molecules, allows an earlier starting of DMTs. Moreover, TB screening may contribute to reduce the transmission, morbidity, and mortality of active disease in global population.

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Presenter Of 1 Presentation

Disease Modifying Therapies – Risk Management Poster Presentation

P0354 - Management of infectious risk in multiple sclerosis: implication for screening, prophylaxis and therapies (ID 1839)

Speakers
Presentation Number
P0354
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

Background

The DMTs largely used in MS may result in higher risk of infectious complications. Screening for and treatment of latent tuberculosis infection (LTBI) should be considered for patients receiving alemtuzumab, teriflunomide, fingolimod and natalizumab. Hepatitis B virus (HBV) reactivation may be harmful mainly for ocrelizumab and alemtuzumab treated patients.

Objectives

Aim of the study was to define the infectious risk in DMTs-treated MS patients with approaches tailored to individual patients.

Methods

At the Neuroinfectious Unit of Policlinico Umberto I (Rome), before starting or switching to DMTs, MS patients were evaluated for infectious risk. HBV and Mycobacterium tuberculosis (MTB) were investigated by serological test as hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B core antibody (HBcAb), and by quantiFERON®-TB Gold In-Tube (QFT) assay, respectively. HBV-DNA detection was performed in chronic hepatitis B MS patients and monthly monitored during DMTs. In QFT positive patients, active tuberculosis (TB) was excluded by medical history and chest X-ray and when necessary, sputum smear microscopy, sputum culture and MTB PCR were also performed. All LTBI patients were undergone to TB prophylaxis (isoniazid+rifampicin) for 3 months. DMTs were started after one-month prophylaxis.

Results

One hundred thirty-eight MS patients (79 females, 59 males) with a median age [interquartile range (IQR)] of 47.5 (37-56), median years of disease (IQR) of 8 (2-18) and median EDSS (IQR) of 3.5 (2-6), were enrolled. Before starting DMTs, 10.1% (14/138) of patients had chronic B hepatitis and 10.1% (14/138) showed QFT positivity. During DMTs follow-up, one patient revealed HBV reactivation. The patient remained asymptomatic with liver enzymes unchanged. HBV-DNA became undetectable after 2 weeks of specific antiviral treatment without discontinuing ocrelizumab. Among QFT positive patients, no TB reactivation was observed. Interestingly, one of the QFT negative patients became positive during fingolimod treatment.

Conclusions

HBV and TB screening should be recommended in MS patients candidate for DMTs. HBV monitoring may avoid a fatal event and the choice of a preemptive strategy spares HBV prophylaxis when unnecessary. Beside preventing TB reactivation, TB prophylaxis based on two active molecules, allows an earlier starting of DMTs. Moreover, TB screening may contribute to reduce the transmission, morbidity, and mortality of active disease in global population.

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