Purpose of Review

The newer, higher-efficacy disease-modifying therapies (DMTs) for multiple sclerosis (MS)—orals and monoclonals—have more profound immunomodulatory and immunosuppressive properties than the older, injectable therapies and require risk mitigation strategies to reduce the risk of serious infections. This review will provide a systematic framework for infectious risk mitigation strategies relevant to these therapies.

Recent Findings

We classify risk mitigation strategies according to the following framework: (1) screening and patient selection, (2) vaccinations, (3) antibiotic prophylaxis, (4) laboratory and MRI monitoring, (5) adjusting dose and frequency of DMT, and (6) behavioral modifications to limit the risk of infection. We systematically apply this framework to the infections for which risk mitigations are available: hepatitis B, herpetic infections, progressive multifocal leukoencephalopathy, and tuberculosis. We also discuss up-to-date recommendations regarding COVID-19 vaccinations for patients on DMTs.

Summary

We offer a practical, comprehensive, DMT-specific framework of derisking strategies designed to minimize the risk of infections associated with the newer MS therapies.

中文翻译：

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多发性硬化症患者口服和单克隆疾病缓解疗法的感染缓解策略

 审查目的

新型、高效的多发性硬化症 (MS) 疾病缓解疗法 (DMT)（口服疗法和单克隆疗法）比旧的注射疗法具有更深远的免疫调节和免疫抑制特性，并且需要风险缓解策略来降低严重感染的风险。本综述将为与这些疗法相关的感染风险缓解策略提供系统框架。

 最近的发现

我们根据以下框架对风险缓解策略进行分类：(1) 筛查和患者选择，(2) 疫苗接种，(3) 抗生素预防，(4) 实验室和 MRI 监测，(5) 调整 DMT 的剂量和频率，以及 ( 6）改变行为以限制感染风险。我们系统地将这一框架应用于可降低风险的感染：乙型肝炎、疱疹感染、进行性多灶性白质脑病和结核病。我们还讨论了有关接受 DMT 的患者接种 COVID-19 疫苗的最新建议。

 概括

我们提供实用、全面、针对 DMT 的降低风险策略框架，旨在最大程度地降低与较新的多发性硬化症疗法相关的感染风险。