Multiple Sklerose: Infektionsprophylaxe und Impfungen

Seifert-Held, Thomas

In multiple sclerosis, highly effective disease-modifying therapies are associated with the risk of infectious diseases, and substance-specific aspects must be considered. Hepatitis B reactivation may occur with anti-CD20 treatments. A screening for latent tuberculosis is recommended before treatment with teriflunomide, cladribine and alemtuzumab. To stratify for the risk of progressive multifocal leukoencephalopathy with natalizumab treatment, the anti-JCV-antibody index is established. Prevention of varicella zoster virus (VZV) infection is recommended prior to treatment with fingolimod, cladribine and alemtuzumab. Vaccinations should be completed before the start of a highly effective disease-modifying treatment. Live-attenuated vaccines, e.g. the VZV vaccine, have to be administered at least 4 weeks before and should not be given during treatment. Vaccine efficacy is reduced when given with highly effective disease-modifying treatments. In the current COVID-19 (coronavirus disease 2019) pandemic, highly effective disease-modifying therapies are considered to confer an increased risk. The currently (January 2021) approved SARS-CoV‑2 (severe acute respiratory syndrome coronavirus type 2) vaccines can be administered with concomitant disease-modifying therapies.