Contributions
Abstract: EP1663
Type: Poster Sessions
Abstract Category: Therapy - Risk management for disease modifying treatments
Introduction: Moderate to high efficacy treatments for multiple sclerosis (MS) are biological or immunosuppressor drugs that increase the risk of opportunistic infections, as tuberculosis (TB).
Aims: To describe the prevalence and treatment of latent tuberculosis infection (LTBI) in MS patients who are candidates for Natalizumab or Fingolimod in a Portuguese tertiary centre.
Methods: Retrospective chart review of relapsing-remitting MS patients that received Fingolimod or Natalizumab as first second-line therapy between 2007-2018. We analysed TB screening, its results, prophylactic treatment regimens and related complications. The recommended method for screening is the interferon-gamma assay (IGRA), after exclusion of active TB. Tuberculin skin test was used simultaneously in some patients.
Results: We identified a total of 91 patients for analysis. At the time of screening our cohort had a mean age of 36.4 years (SD= 9.3) and 60 (65.9%) were women. Thirty-three (36.3%) were current or past smokers. Mean duration of disease was 8.7 years (SD= 6.9) and median EDSS was 3.5 (min=0; max=6). Only 13 patients (14.3%) were treatment-naïve and the average days of corticosteroid therapy in the previous 2 years was 5.5 (SD=4.5). Forty-four (48.4%) patients received Fingolimod and 47 (51.6%) Natalizumab. Screening with IGRA was performed in all but 7 patients. The results were as follows: 62 (68%) negative, 13 positive (14.3%) and 9 (9.9%) indeterminate. Twenty-eight patients (30.8%) received prophylactic therapy for LTBI, mostly with a 9-month course of isoniazid (23/28=82.1%). The median interval between treatment for MS and for LTBI was 2 months (min=0; max=17). Hepatotoxicity was reported in 4 patients.
Conclusions: Our results highlight the importance of tuberculosis screening in MS patients before immunosuppression. Positively screened patients should be treated for LTBI and may start therapy after 1 to 2 months. In our patients preventive regimen for LTBI was safe and well tolerated.
Disclosure: All authors have nothing to disclose.
Abstract: EP1663
Type: Poster Sessions
Abstract Category: Therapy - Risk management for disease modifying treatments
Introduction: Moderate to high efficacy treatments for multiple sclerosis (MS) are biological or immunosuppressor drugs that increase the risk of opportunistic infections, as tuberculosis (TB).
Aims: To describe the prevalence and treatment of latent tuberculosis infection (LTBI) in MS patients who are candidates for Natalizumab or Fingolimod in a Portuguese tertiary centre.
Methods: Retrospective chart review of relapsing-remitting MS patients that received Fingolimod or Natalizumab as first second-line therapy between 2007-2018. We analysed TB screening, its results, prophylactic treatment regimens and related complications. The recommended method for screening is the interferon-gamma assay (IGRA), after exclusion of active TB. Tuberculin skin test was used simultaneously in some patients.
Results: We identified a total of 91 patients for analysis. At the time of screening our cohort had a mean age of 36.4 years (SD= 9.3) and 60 (65.9%) were women. Thirty-three (36.3%) were current or past smokers. Mean duration of disease was 8.7 years (SD= 6.9) and median EDSS was 3.5 (min=0; max=6). Only 13 patients (14.3%) were treatment-naïve and the average days of corticosteroid therapy in the previous 2 years was 5.5 (SD=4.5). Forty-four (48.4%) patients received Fingolimod and 47 (51.6%) Natalizumab. Screening with IGRA was performed in all but 7 patients. The results were as follows: 62 (68%) negative, 13 positive (14.3%) and 9 (9.9%) indeterminate. Twenty-eight patients (30.8%) received prophylactic therapy for LTBI, mostly with a 9-month course of isoniazid (23/28=82.1%). The median interval between treatment for MS and for LTBI was 2 months (min=0; max=17). Hepatotoxicity was reported in 4 patients.
Conclusions: Our results highlight the importance of tuberculosis screening in MS patients before immunosuppression. Positively screened patients should be treated for LTBI and may start therapy after 1 to 2 months. In our patients preventive regimen for LTBI was safe and well tolerated.
Disclosure: All authors have nothing to disclose.