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Infection Risks Among pwMS Treated With Fingolimod, Natalizumab, Rituximab

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    Infection Risks Among pwMS Treated With Fingolimod, Natalizumab, Rituximab

    Question: What is the risk of infections in association with different disease-modifying treatments for multiple sclerosis?

    Findings: This nationwide cohort study found that patients with multiple sclerosis are at a generally increased risk of infections, and this risk is partly dependent on the choice of treatment. The rate of infections was lowest with injectable therapies; among newer treatments, use of rituximab was associated with the highest rate of serious infections but less use of herpes antiviral medications compared with fingolimod and natalizumab.

    Meaning: Per the results of this study, physicians and patients should be aware of infection risks associated with newer multiple sclerosis treatments and perhaps particularly anti-CD20 therapies.

    https://jamanetwork.com/journals/jam...stract/2752284
    1st sx '89 Dx '99 w/RRMS - SP since 2010
    Administrator Message Boards/Moderator

    #2
    Questions

    Thank you for providing the study link, but reading the abstract left me with some questions. If you were able to read the study itself, perhaps you can answer them.

    1) The primary outcome was serious infections requiring hospitalization; additional outcomes, being prescribed antibiotics/herpes antivirals; in the results section, however, the authors just referred to infections. Does "infections" just include serious infections or are all infection requiring antibiotics/antivirals included?

    2) Were the individuals in the "comparator cohort of 42 645 individuals" people with MS? There is nothing in the abstract to indicate that they are. If one is looking at the effects of DMDs on infection rates it seems like the comparator cohort should be people-with-MS-not-on-DMDs.

    3) Is the "crude rate" of an adverse event meaningful? And what confounders were included? Time since initial MS diagnosis? Disability level?

    In trying to find out if people with MS in general (not just those on DMDs) were at higher risk of infection, I found this article which I felt made some very good points: Is multiple sclerosis a risk factor for infections? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204651/

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