Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India; Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, United States.
Department of Neurology, Geisinger Medical Center, Danville, Palestine, United States; Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, United States.
Mult Scler Relat Disord. 2022 Mar;59:103675. doi: 10.1016/j.msard.2022.103675. Epub 2022 Feb 8.
Sphingosine-1-phosphate (S1P) receptor modulators are a new class of oral disease-modifying therapies used for Multiple Sclerosis (MS). These are immunomodulatory drugs and can thus increase the risk of certain infections in these patients. This paper summarizes the existing data on the most common opportunistic infections associated with the drugs in this class: Varicella Zoster Virus (VZV), Herpes Simplex Virus (HSV), and Cryptococcus neoformans. A literature review and descriptive analysis of reported cases and clinical phase III study findings on the incidences of these infections were conducted using PubMed and Google Scholar. Results regarding fingolimod, siponimod, ozanimod, and ponesimod were obtained. Overall, the incidence of these infections was found to be extremely low in MS patients treated with S1P receptor modulators. Among the four drugs in this class, the incidence rates of VZV, HSV, and cryptococcal infections were either similar or slightly higher than placebo, with some infections not reported in cases of ozanimod and ponesimod. Most of these resulted in favorable outcomes, with very few disabilities or fatalities. However, this paper highlights the increasing relevance of assessing infectious risk factors to promote the early identification of serious complications related to these drugs. Opportunistic infections should be considered in the differential diagnosis of an MS relapse in the setting of disease-modifying treatment.
鞘氨醇-1-磷酸（S1P）受体调节剂是一类新型的口服疾病修正治疗药物，用于多发性硬化症（MS）。这些是免疫调节药物，因此会增加这些患者发生某些感染的风险。本文总结了与该类药物相关的最常见机会性感染的现有数据：水痘带状疱疹病毒（VZV）、单纯疱疹病毒（HSV）和新型隐球菌。使用 PubMed 和 Google Scholar 对报告病例和临床 III 期研究中这些感染发生率的现有数据进行了文献回顾和描述性分析。获得了关于 fingolimod、siponimod、ozanimod 和 ponesimod 的结果。总体而言，在接受 S1P 受体调节剂治疗的 MS 患者中，这些感染的发生率极低。在该类四种药物中，VZV、HSV 和隐球菌感染的发生率与安慰剂相似或略高，ozanimod 和 ponesimod 未报告某些感染。这些感染大多结果良好，仅有极少数残疾或死亡。然而，本文强调了评估感染风险因素的相关性不断增加，以促进早期识别与这些药物相关的严重并发症。在疾病修正治疗的背景下，应将机会性感染纳入 MS 复发的鉴别诊断中。
