Newer MS therapies tied to heightened infection risk

  • Luna G & al.
  • JAMA Neurol
  • 7 Oct 2019

  • International Clinical Digest
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Takeaway

  • Patients with relapsing-remitting multiple sclerosis (MS) starting newer disease-modifying therapies had elevated risks for infections requiring hospitalization that varied by drug.

Why this matters

  • Better understanding of these risks will help inform treatment decisions.

Key results

  • Compared with crude infection incidence rate per 1000 person-years in general population (5.2), rate higher in patients receiving:
    • Interferon-β (Avonex, Betaseron, Extavia, Rebif) and glatiramer acetate (Copaxone) (8.9).
    • Fingolimod (Gilenya) (14.3).
    • Natalizumab (Tysabri) (11.4).
    • Rituximab (Rituxan) (19.7).
  • When interferon-β and glatiramer acetate were comparator, adjusted risk significantly higher only for rituximab (HR, 1.70; 95% CI, 1.11-2.61).
  • Relative to use with interferon-β and glatiramer acetate:
    • Use of antibiotics higher with natalizumab (HR, 1.15; 95% CI, 1.01-1.31), rituximab (HR, 1.23; 95% CI, 1.08-1.40).
    • Use of herpes antiviral drugs higher with fingolimod (HR, 1.82; 95% CI, 1.34-2.46), natalizumab (HR, 1.71; 95% CI, 1.27-2.32).

Study design

  • Swedish 7-year nationwide retrospective cohort study:
    • 6421 patients with relapsing-remitting MS initiating study drug.
    • 42,645 age-, sex-matched MS-free individuals from general population.
  • Main outcome: serious infections (those resulting in hospitalization).
  • Funding: Patient-Centered Outcomes Research Institute; Swedish Foundation for MS Research.

Limitations

  • Reliance on registry data.
  • Minor infections missed.
  • Lack of information on some confounders.

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