Contributions
Abstract: EP1662
Type: Poster Sessions
Abstract Category: Therapy - Risk management for disease modifying treatments
Disease-modifying therapies (DMT) for Multiple Sclerosis (MS) especially non-BRACE drugs raise concerns about infectious risk. Our aim was to analyse the result of a systematic Infectious Diseases consultation (IDC) in a cohort of MS patients about to be treated or already in treatment with non-BRACE DMT.
We collected data from clinical records of MS patients followed simultaneously in the MS Clinic and IDC (2010-2017): demographics, diagnosis, treatment, prior infections, immunizations, prophylaxis and infectious complications.
We found 104 patients (73 females) planned to begin (17 naïve) or switch (87) to a non-BRACE DMT: natalizumab (44), fingolimod (32), dimethylfumarate (16), teriflunomide (6) or rituximab (6). At first IDC, median age was 36 years (IQR 16.8), disease duration was 5.8 years (IQR 7.45) and 27 patients had already started non-BRACE DMT. In 25 (24%) patients a diagnosis of latent tuberculosis (TB) was elicited, 88% of whom were treated due to high risk of TB reactivation. We found a positive varicella-zoster virus (VZV) IgG or a history of varicella in 95 patients and a negative or borderline VZV antibodies in 7 (2 patients were not tested); 53 patients were not immune to Hepatitis B and 47 to Hepatitis A. Vaccination was recommended in all seronegative cases prior to new DMT, which could be done in 6 patients for VZV, 48 for Hepatitis B and 37 patients for Hepatitis A. Due to recurrent genital herpes infection, prophylaxis was done in 1 patient. In 2 patients, low CD4+ count prompted Pneumocystis jirovecii chemoprophylaxis. Anti-pneumococcal vaccines were recommended in all cases. In infectious diseases surveillance, 12 patients had urinary tract infections; 8 upper respiratory tract infections; 2 gastroenteritis and 1 tracheobronchitis, herpes-zoster, pustulosis and human papillomavirus related cervical lesion. Two patients were hospitalized due to chickenpox (1 patient already under natalizumab was not vaccinated) and CMV-EBV co-infection, both recovered.
Epidemiology in Portugal places tuberculosis as an important infection to screen, as here confirmed. We underline the high number of patients that were vaccinated which together with prophylaxis measures significantly reduced the risk of infections and allowed a more confident use of the chosen DMT. This study brings important information about the healthcare in MS, highlighting the role of IDC in the individualized observation and risk assessment in the era of enlarging number of DMT.
Disclosure: Daniela Ferro: nothing to disclose; Beatriz Prista-Leão: nothing to disclose; Andreia Costa: nothing to disclose; Pedro Abreu: nothing to disclose; Joana Guimarães: nothing to disclose; Jorge Reis: nothing to disclose; Teresa Mendonça: nothing to disclose; André Pinto: nothing to disclose; Cândida Abreu: nothing to disclose; António Sarmento: nothing to disclose; Maria José Sá: nothing to disclose
Abstract: EP1662
Type: Poster Sessions
Abstract Category: Therapy - Risk management for disease modifying treatments
Disease-modifying therapies (DMT) for Multiple Sclerosis (MS) especially non-BRACE drugs raise concerns about infectious risk. Our aim was to analyse the result of a systematic Infectious Diseases consultation (IDC) in a cohort of MS patients about to be treated or already in treatment with non-BRACE DMT.
We collected data from clinical records of MS patients followed simultaneously in the MS Clinic and IDC (2010-2017): demographics, diagnosis, treatment, prior infections, immunizations, prophylaxis and infectious complications.
We found 104 patients (73 females) planned to begin (17 naïve) or switch (87) to a non-BRACE DMT: natalizumab (44), fingolimod (32), dimethylfumarate (16), teriflunomide (6) or rituximab (6). At first IDC, median age was 36 years (IQR 16.8), disease duration was 5.8 years (IQR 7.45) and 27 patients had already started non-BRACE DMT. In 25 (24%) patients a diagnosis of latent tuberculosis (TB) was elicited, 88% of whom were treated due to high risk of TB reactivation. We found a positive varicella-zoster virus (VZV) IgG or a history of varicella in 95 patients and a negative or borderline VZV antibodies in 7 (2 patients were not tested); 53 patients were not immune to Hepatitis B and 47 to Hepatitis A. Vaccination was recommended in all seronegative cases prior to new DMT, which could be done in 6 patients for VZV, 48 for Hepatitis B and 37 patients for Hepatitis A. Due to recurrent genital herpes infection, prophylaxis was done in 1 patient. In 2 patients, low CD4+ count prompted Pneumocystis jirovecii chemoprophylaxis. Anti-pneumococcal vaccines were recommended in all cases. In infectious diseases surveillance, 12 patients had urinary tract infections; 8 upper respiratory tract infections; 2 gastroenteritis and 1 tracheobronchitis, herpes-zoster, pustulosis and human papillomavirus related cervical lesion. Two patients were hospitalized due to chickenpox (1 patient already under natalizumab was not vaccinated) and CMV-EBV co-infection, both recovered.
Epidemiology in Portugal places tuberculosis as an important infection to screen, as here confirmed. We underline the high number of patients that were vaccinated which together with prophylaxis measures significantly reduced the risk of infections and allowed a more confident use of the chosen DMT. This study brings important information about the healthcare in MS, highlighting the role of IDC in the individualized observation and risk assessment in the era of enlarging number of DMT.
Disclosure: Daniela Ferro: nothing to disclose; Beatriz Prista-Leão: nothing to disclose; Andreia Costa: nothing to disclose; Pedro Abreu: nothing to disclose; Joana Guimarães: nothing to disclose; Jorge Reis: nothing to disclose; Teresa Mendonça: nothing to disclose; André Pinto: nothing to disclose; Cândida Abreu: nothing to disclose; António Sarmento: nothing to disclose; Maria José Sá: nothing to disclose