Matteo Tartaglia (Italy)
Sapienza University of Rome, Italy Department of Human NeurosciencesAuthor Of 1 Presentation
ASSESSMENT AND MANAGEMENT OF INFECTIOUS RISK IN MULTIPLE SCLEROSIS PATIENTS TREATED WITH DISEASE-MODIFYING THERAPIES
- Maria Antonella Zingaropoli (Italy)
Abstract
Background and Aims:
We aim to define the infectious risk in DMT-treated MS patients with approaches tailored to individual patients.
Methods:
At the Neuroinfectious Unit of Policlinico Umberto I Hospital, Sapienza University of Rome, MS patients were evaluated for infectious risk before starting, switching or during DMT-treatment. The evaluation consisted in two levels: a first level common to each patient and a second-one specific for those positive patients at the first level.
Results:
From February 1, 2018 to April 1, 2021, 174 MS patients were enrolled. The first level identified 18 patients with anti-HBc+, 4 patients with anti-HCV+, 19 patients with QuantiFERON®-TB Gold In-Tube (QFT)+. A specific second level was performed. No anti-HBc+ patients showed a detectable HBV-DNA. These patients were defined as past HBV infected and started DMT-treatment. No anti-HCV+ patients showed HCV-RNA detectable, thus patients started DMT-treatment. Among QTB+ patients the second level infectious risk assessment identified 17 latent TB infection (LTBI) and 2 active TB infection. After one month of LTBI prophylaxis or TB treatment, respectively, patients started DMT. During DMT-treatment one ocrelizumab-treated anti-HBc+ patient revealed HBV reactivation, one IFN-β-treated, three natalizumab-, two ocrelizumab-treated patients showed a reactivation of HSV-1, one cladribine-treated patient showed a VZV reactivation. No TB reactivation was observed. All the latent infection reactivations have been successfully treated.
Conclusions:
Extensive screening of infectious disease should be recommended in MS patient candidate for DMTs to mitigate the infectious risk. During DMT-treatment, a regular assessment of infectious risk allows to avoid discontinuing MS therapy and guarantee the safety of the patient.