The risk of infections for multiple sclerosis and neuromyelitis optica spectrum disorder disease-modifying treatments: Eighth European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop Review. April 2021

Author:

Tur Carmen1ORCID,Dubessy Anne-Laure2,Otero-Romero Susana1,Amato Maria Pia3ORCID,Derfuss Tobias4ORCID,Di Pauli Franziska5,Iacobaeus Ellen6,Mycko Marcin7,Abboud Hesham8ORCID,Achiron Anat9ORCID,Bellinvia Angelo10,Boyko Alexey11,Casanova Jean-Laurent12,Clifford David13,Dobson Ruth14ORCID,Farez Mauricio F15,Filippi Massimo16ORCID,Fitzgerald Kathryn C17ORCID,Fonderico Mattia10ORCID,Gouider Riadh18,Hacohen Yael19,Hellwig Kerstin20ORCID,Hemmer Bernhard21ORCID,Kappos Ludwig22,Ladeira Filipa23ORCID,Lebrun-Frénay Christine24ORCID,Louapre Céline25,Magyari Melinda26ORCID,Mehling Matthias4,Oreja-Guevara Celia27ORCID,Pandit Lekha28ORCID,Papeix Caroline25ORCID,Piehl Fredrik6,Portaccio Emilio10ORCID,Ruiz-Camps Isabel29,Selmaj Krzysztof30,Simpson-Yap Steve31ORCID,Siva Aksel32ORCID,Sorensen Per Soelberg33,Sormani Maria Pia34ORCID,Trojano Maria35,Vaknin-Dembinsky Adi36,Vukusic Sandra37ORCID,Weinshenker Brian38,Wiendl Heinz39ORCID,Winkelmann Alexander40,Zuluaga Rodas María Isabel41,Tintoré Mar1ORCID,Stankoff Bruno2

Affiliation:

1. Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain

2. Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/ Department of Neurology, Saint Antoine Hospital, AP-HP, Paris, France

3. Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy

4. Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland

5. Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

6. Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden

7. Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland

8. Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland Medical Center, Cleveland, OH, USA

9. Sheba Medical Center at Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

10. Department of NEUROFARBA, University of Florence, Florence, Italy

11. Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia/Institute of Clinical Neurology and Department of Neuroimmunology, Federal Center of Brain Research and Neurotechnologies, Moscow, Russia

12. St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA

13. Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA

14. Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK/Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK

15. Center for Research on Neuroimmunological Diseases, FLENI, Buenos Aires, Argentina

16. Neurology Unit, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy

17. Department of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD, USA

18. Department of Neurology, Razi Hospital, Tunis, Tunisia

19. Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK

20. Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany

21. Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany

22. Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland

23. Neurology Department, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

24. CRCSEP Côte d’Azur, CHU de Nice Pasteur 2, UR2CA-URRIS, Université Nice Côte d’Azur, Nice, France

25. Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/Sorbonne University, Paris Brain Institute—ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Paris, France

26. Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Copenhagen, Denmark

27. Department of Neurology, Hospital Clínico San Carlos, Idissc, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain

28. Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, India

29. Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d’Hebron, Barcelona, Spain

30. Collegium Medicum, Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland/Center of Neurology, Lodz, Poland

31. Clinical Outcomes Research Unit, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia

32. Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey

33. Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

34. Department of Health Sciences, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy

35. Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro,” Bari, Italy

36. Hadassah-Hebrew University Medical Center, Department of Neurology, The Agnes-Ginges Center for Neurogenetics Jerusalem, Jerusalem, Israel

37. Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France/Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, Lyon, France

38. Department of Neurology, Mayo Clinic, Rochester, MN, USA

39. Department of Neurology with Institute of Translational Neurology, University of Muenster, Münster, Germany

40. Department of Neurology, University of Rostock, Rostock, Germany

41. MS Clinic, Instituto Neurológico de Colombia and Medicarte, Medellin, Colombia

Abstract

Over the recent years, the treatment of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) has evolved very rapidly and a large number of disease-modifying treatments (DMTs) are now available. However, most DMTs are associated with adverse events, the most frequent of which being infections. Consideration of all DMT-associated risks facilitates development of risk mitigation strategies. An international focused workshop with expert-led discussions was sponsored by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and was held in April 2021 to review our current knowledge about the risk of infections associated with the use of DMTs for people with MS and NMOSD and corresponding risk mitigation strategies. The workshop addressed DMT-associated infections in specific populations, such as children and pregnant women with MS, or people with MS who have other comorbidities or live in regions with an exceptionally high infection burden. Finally, we reviewed the topic of DMT-associated infectious risks in the context of the current SARS-CoV-2 pandemic. Herein, we summarize available evidence and identify gaps in knowledge which justify further research.

Funder

“la Caixa” Foundation

Fundación Merck Salud

Publisher

SAGE Publications

Subject

Neurology (clinical),Neurology

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