Infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society - 22/07/21

Doi : 10.1016/j.neurol.2021.04.011

C. Papeix ^a,⁎ , C. Donze ^b, C. Lebrun-Frénay ^c
French Group for Recommendations in Multiple Sclerosis (France4MS), the Société Francophone de la Sclérose En Plaques (SFSEP)^¹
Steering committee.
Co-Chairs
C. Papeix ^d, C. Donzé ^e, C. Lebrun-Frénay ^f
^d Paris, France
^e Lille, France
^f Nice, France

Group of evaluators Coordinators
D. Laplaud ^g, E. Thouvenot ^h, X. Ayrignac ⁱ, V. Pourcher-Martinez ^j, H. Zéphir ^k, J. de Seze ^l
^g Nantes, France
^h Nîmes, France
ⁱ Montpellier, France
^j Paris, France
^k Lille, France
^l Strasbourg, France

Readers
L. Michel ^m, C. Bensa ⁿ, C. Cara-Dalliere ^o, A.M. Guen-noc ^p, O. Casez ^q, A. Maarouf ^r, B. Bourre ^s, A. Kwiatkowski ^t, M. Cohen ^u, E. Maillart ⁿ, N. Collongues ^v, C. Louapre ⁿ, G. Androdias ^w, A. Guegen ⁿ
^m Rennes, France
ⁿ Paris, France
^o Montpellier, France
^p Tours, France
^q Grenobles, France
^r Marseille, France
^s Rouen, France
^t Lille, France
^u Nice, France
^v Strasbourg, France
^w Lyon, France

Cotator
B. Audoin ^x, G. Mattey ^y, P. Bernady ^z, J.M. Faucheux ^aa, P. Labauge ^ab, C. Meckies ^ac, B. Stankoff ^ad, P. Tourniaire ^ae, A. Dinh ^ad, A.M. Guennoc ^af, F. Durnad-Dubief ^ag, S. Wiertlewski ^ah, N. Derache ^ai, E. Le page ^aj, S. Pittion ^ah, S. Vukusic ^ag, P. Clavelou ^ak, O. Heinzlef ^al, R. Colamarino ^am, E. Planque ^an, A. Rico ^x, C. Sheiber nogueira ^ag, M. de Seze ^ao, J. Ciron ^ap
^x Marseille, France
^y Nancy, France
^z Bayonne, France
^aa Agens, France
^ab Montpellier, France
^ac Toulouse, France
^ad Paris, France
^ae Avignon, France
^af Tours, France
^ag Lyon, France
^ah Nancy, France
^ai Caen, France
^aj Rennes, France
^ak Clermont-Ferrand, France
^al Poissy, France
^am Antibes, France
^an Epinal, France
^ao Bordeaux, France
^ap Toulouse, France

Expert readers (voters)
H. Alchaar ^aq, D. Bensmail ^ar, D. Biotti ^as, P. Branger ^at, B. Brochet ^au, B. Castan ^av, A. Creange ^aw, E. Creisson ^as, T. DeBroucker ^ax, R. Depaz ^ay, X. Douay ^az, C. Dulau ^au, M. Faucher ^ba, M. Fournier ^aq, A. Fromont ^bb, P. Gallien ^bc, O. Gout ^ay, J. Grimaud ^bd, Y. Hervé ^be, A. Kerbrat ^be, L. Kremer ^bf, L. Lanotte ^bf, L. Magy ^bg, A. Mania ^bh, A. Maurousset ^bi, X. Moisset ^bj, A. Montcuquet ^bg, T. Moreau ^bb, N. Morel ^bk, I. Patry ^bl, D. Peaureaux ^as, M.C. Pouget ^bm, A. Ruet ^au, C. Saint-Val ^ay, J.P. Stahl ^bn, F. Taithe ^bj, P. Tattevin ^bc, M. Vaillant ^bn, F. Vuoto ^az
^aq Nice, France
^ar Garches, France
^as Toulouse, France
^at Caen, France
^au Bordeaux, France
^av Périgueux, France
^aw Créteil, France
^ax Saint-Denis, France
^ay Paris, France
^az Lille, France
^ba Bruges, France
^bb Dijon, France
^bc Rennes, France
^bd Chartres, France
^be Carcassonne, France
^bf Strasbourg, France
^bg Limoges, France
^bh Bezier, France
^bi Tours, France
^bj Clermont-Ferrand, France
^bk Annecy, France
^bl Fontenay sous-bois, France
^bm Lyon, France
^bn Grenobles, France

^a Département de neurologie, CRCSEP-Paris, Sorbonne Université, Hôpital de la Pitié salpêtrière, AP–HP 6, Paris 75013, France
^b Faculté de médecine et de maïeutique de Lille, hôpital Saint-Philibert, groupement des hôpitaux de l’institut catholique de Lille, Lomme, France
^c URC2A, Cote d’Azur University, CRCSEP-Côte d’Azur, neurologie, Hôpital Pasteur2, CHU Nice, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 22 July 2021
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Introduction

Viral, bacterial, or fungal infections are suspected of triggering multiple sclerosis (MS) and promoting relapses of the disease and are likely to be promoted by immune-active treatments. This raises questions about the infectious workup and preventive treatment of these infections prior to their initiation.

Objectives

To establish recommendations on infections and MS. Provide information to patients and healthcare professionals on the minimal infectious workup to be performed in an MS patient at diagnosis and prior to initiation of immuno-active therapy in MS.

Methods

The recommendation attempts to answer four main questions about infections and MS. The French Group for Recommendations in Multiple Sclerosis (France4MS) did a systematic review of articles from PubMed and universities databases (from January 1975 to June 2020), using the RAND/UCLA formalized consensus method. The RAND/UCLA method has been developed to synthesize the scientific literature and expert opinions on health care topics and was used for reaching a formal agreement. Twenty-three experts contributed to the detailed review and a group of 63 multidisciplinary health professionals validated the final version of 36 recommendations.

Results

It is recommended that MS patients undergo a minimal infectious workup, check their vaccination status at diagnosis, and repeat it during follow-up and before starting immunotherapy. Screening and preventive treatment of viral (group Herpes virus, HPV, JCV, HCV, HBV), bacterial (mycobacteria) and fungal (Cryptococcus) infections is recommended prior to the initiation of certain immuno-active MS therapies.

Discussion and conclusions

At diagnosis of MS and prior to the choice of therapeutic strategy, it is recommended to update the vaccination schedule of MS patients in reference to the HCSP vaccination schedule and the SFSEP recommendations. Before starting immunosuppressive treatment, it is recommended to inform patients of the risks of infections and to look for a constitutive or acquired immune deficiency. Health professionals and patients should be informed of the updated recommendations on infections and MS.

Le texte complet de cet article est disponible en PDF.

Keywords : Multiple sclerosis, Infections, Prevention, Immuno-active treatment