口服和单克隆疾病修正治疗多发性硬化症患者的感染缓解策略。
Infection Mitigation Strategies for Multiple Sclerosis Patients on Oral and Monoclonal Disease-Modifying Therapies.
机构信息
Department of Neurology, NYU-Multiple Sclerosis Care Center, NYU School of Medicine, New York, NY, USA.
, New York, NY, USA.
出版信息
Curr Neurol Neurosci Rep. 2021 May 19;21(7):36. doi: 10.1007/s11910-021-01117-y.
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. We offer a practical, comprehensive, DMT-specific framework of derisking strategies designed to minimize the risk of infections associated with the newer MS therapies.
目的综述
新型高效多发性硬化症（MS）治疗药物（DMT）-口服药和单克隆抗体比传统的注射型 DMT 具有更强的免疫调节和免疫抑制作用，因此需要采取风险缓解策略来降低严重感染的风险。本篇综述将提供一个与这些治疗药物相关的感染风险缓解策略的系统框架。
最新发现
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）行为改变以限制感染的风险。我们系统地将这一框架应用于有可用风险缓解措施的感染：乙型肝炎、疱疹感染、进行性多灶性白质脑病和结核病。我们还讨论了针对正在接受 DMT 治疗的患者的 COVID-19 疫苗接种的最新建议。我们提供了一个实用、全面、针对 DMT 的风险降低策略框架，旨在最大程度地降低与新型 MS 治疗相关的感染风险。
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