Infections in patients with multiple sclerosis treated with disease-modifying therapies: A comparative risk assessment cohort study

Mohammad Reza  Fattahi; Amir  Valizadeh; Amirreza  Azimi; Abdorreza Naser  Moghadasi; Moein  Ghasemi; Samira  Navardi; Rozita  Doosti; Zahra  Hemmati; Ali  Zare-Dehnavi; Arad  Iranmehr; Sara  Hamtaei-Gashti; Mohammad Ali  Sahraian

doi:10.18502/cjn.v24i2.20684

Mohammad Reza Fattahi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Amir Valizadeh Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Amirreza Azimi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Abdorreza Naser Moghadasi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Moein Ghasemi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Samira Navardi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Rozita Doosti Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Zahra Hemmati Department of Stroke, Epsom and St Helier University Hospitals, Epsom, KT18 7EG, UK
Ali Zare-Dehnavi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Arad Iranmehr Neurosurgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Sara Hamtaei-Gashti Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Ali Sahraian Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/cjn.v24i2.20684

Keywords: Multiple Sclerosis; Infections; Interferons; Fingolimod; Rituximab; Azathioprine

Abstract

Background: The major treatment regimens for multiple sclerosis (MS) are disease-modifying therapies (DMTs). Fungal, viral, and bacterial infections are common complications of these drugs. Also, MS itself is an immune-related chronic disease that can compromise their subjects to infections. Therefore, MS can be a risk factor for infectious complications.

Methods: This paper is a retrospective cohort study conducted from February 2020 to January 2022 using prospectively collected data from every patient registered at the Multiple Sclerosis Referral Research Center in Tehran, Iran. We inducted patients with MS who were diagnosed based on McDonald's criteria and exposed to DMTs for at least 6 months prior to this study. Being under 18 years of age, diagnosis change during the study, and mortality were the exclusion criteria of this study.

Results: We inducted a total of 979 patients into this study. Rituximab and natalizumab were associated with a higher risk of urinary tract infection (UTI) and bacterial vaginitis. Moreover, rituximab, glatiramer acetate, and dimethyl fumarate were associated with HSV-associated ulceration. None of the investigated DMTs were associated with an altered risk of COVID-19.

Conclusion: The use of DMTs can result in an increased risk of infections in patients. The selection of these DMTs should be based on their efficacy and risk of complications. Healthcare providers should familiarize themselves with these complications to select the appropriate DMTs with the highest efficacy.