接受疾病修正治疗的多发性硬化症患者的感染风险：一项为期三年的观察性队列研究。
Infectious risk in multiple sclerosis patients treated with disease-modifying therapies: A three-year observational cohort study.
作者信息
Zingaropoli Maria Antonella, Pasculli Patrizia, Iannetta Marco, Perri Valentina, Tartaglia Matteo, Crisafulli Sebastiano Giuseppe, Merluzzo Chiara, Baione Viola, Mazzochi Lorenzo, Taglietti Ambra, Pauri Flavia, Frontoni Marco, Altieri Marta, Gaeta Aurelia, Antonelli Guido, Conte Antonella, Mastroianni Claudio Maria, Ciardi Maria Rosa
机构信息
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
Department of System Medicine, Tor Vergata University of Rome, Italy.
出版信息
Mult Scler J Exp Transl Clin. 2022 Jan 4;8(1):20552173211065731. doi: 10.1177/20552173211065731. eCollection 2022 Jan-Mar.
BACKGROUND
The disease-modifying therapies (DMTs) largely used in multiple sclerosis (MS) may result in higher infectious risk.
OBJECTIVE
We aimed to investigate the infectious risk in DMT-treated MS patients.
METHODS
MS patients were evaluated for infectious risk before starting, switching or during DMT.
RESULTS
In this three-year observational cohort study 174 MS patients were enrolled. Among them, 18 patients were anti-HBc + and 19 patients were QuantiFERON®-TB Gold In-Tube (QFT) + . No patients with anti-HBc + showed a detectable HBV-DNA and all started DMT. Among QTB + patients, 17 latent TB infections (LTBIs) and 2 active TB infections (TBIs) were identified. After one month of LTBI prophylaxis or TB treatment, respectively, all patients started DMTs.Overall, 149 started DMTs. During DMTs, one ocrelizumab-treated patient with anti-HBc + developed HBV reactivation and six patients (3 on natalizumab, 2 on ocrelizumab and 1 on IFN-β) showed reactivation of HSV-1, with detectable plasma DNA. Finally, 1 cladribine-treated patient experienced VZV reactivation. All the reactivations of latent infections have been successfully treated.
CONCLUSION
Screening of infectious diseases in DMT candidate MS patients helps to mitigate the infectious risk. During DMTs, a regular assessment of infectious risk allows to avoid discontinuing MS therapy and guarantees a higher degree of safety.
背景
多发性硬化症（MS）中大量使用的疾病修正疗法（DMTs）可能会导致更高的感染风险。
目的
我们旨在调查接受DMT治疗的MS患者的感染风险。
方法
对MS患者在开始、转换或接受DMT治疗期间的感染风险进行评估。
结果
在这项为期三年的观察性队列研究中，纳入了174例MS患者。其中，18例患者抗-HBc阳性，19例患者全血γ干扰素释放试验（QFT）阳性。抗-HBc阳性的患者均未检测到HBV-DNA，且均开始接受DMT治疗。在QFT阳性患者中，确诊17例潜伏性结核感染（LTBI）和2例活动性结核感染（TBI）。在分别进行1个月的LTBI预防或结核病治疗后，所有患者均开始接受DMT治疗。总体而言，149例患者开始接受DMT治疗。在DMT治疗期间，1例接受奥瑞珠单抗治疗的抗-HBc阳性患者发生HBV再激活，6例患者（3例接受那他珠单抗治疗，2例接受奥瑞珠单抗治疗，1例接受干扰素-β治疗）出现HSV-1再激活，血浆DNA可检测到。最后，1例接受克拉屈滨治疗的患者发生VZV再激活。所有潜伏感染的再激活均得到成功治疗。
结论
对DMT候选MS患者进行传染病筛查有助于降低感染风险。在DMT治疗期间，定期评估感染风险可避免中断MS治疗，并保证更高的安全性。
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