Infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society

Caroline Papeix (1) , Cécile Donze (2) , Christine Lebrun-Frénay (3) , French Group For Recommendations In Multiple Sclerosis The Société Francophone de La Sclérose En Plaques , D. Laplaud (4) , Eric Thouvenot (5, 6) , Xavier Ayrignac (7, 8) , V. Pourcher-Martinez (9) , H. Zéphir (2) , J. de Seze (10) , L. Michel (11) , C. Bensa (9) , C. Cara-Dalliere (7) , A.M. Guen-Noc (12) , O. Casez (13) , A. Maarouf (14, 15, 16, 17) , B. Bourre (18) , A. Kwiatkowski (2) , M. Cohen (19) , E. Maillart (9) , N. Collongues (10) , C. Louapre (9) , G. Androdias (20) , A. Guegen (9) , B. Audoin (21) , G. Mattey (22) , P. Bernady , J.M. Faucheux , Pierre Labauge (7, 23) , C. Meckies (24) , B. Stankoff (9) , P. Tourniaire (25) , A. Dinh (9) , A.M. Guennoc (12) , F. Durnad-Dubief (20) , S. Wiertlewski (22) , N. Derache (26) , E. Le Page (11) , S. Pittion (22) , S. Vukusic (20) , P. Clavelou (27) , O. Heinzlef (28) , R. Colamarino (29) , E. Planque (30) , A. Rico (21) , C. Sheiber Nogueira (20) , M. de Seze (31) , J. Ciron (24) , H. Alchaar (19) , D. Bensmail (32) , D. Biotti (24) , P. Branger (26) , B. Brochet (31) , B. Castan (33) , A. Creange (34) , E. Creisson (24) , T. Debroucker (35) , R. Depaz (9) , X. Douay (2) , C. Dulau (31) , M. Faucher , M. Fournier (19) , A. Fromont (36) , P. Gallien (11) , O. Gout (9) , J. Grimaud , Y. Hervé , A. Kerbrat , L. Kremer (10) , L. Lanotte (10) , L. Magy (37) , A. Mania , A. Maurousset (12) , X. Moisset (27) , A. Montcuquet (37) , T. Moreau (36) , N. Morel (38) , I. Patry , D. Peaureaux (24) , M.C. Pouget (20) , A. Ruet (31) , C. Saint-Val (9) , J.P. Stahl (13) , F. Taithe (27) , P. Tattevin (11) , M. Vaillant (13) , F. Vuoto (2)

1 CHU Pitié-Salpêtrière [AP-HP]
2 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
3 CHU Nice [Cimiez]
4 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
5 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
6 IGF - Institut de Génomique Fonctionnelle
7 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
8 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
9 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
10 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
11 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
12 CHU Trousseau [Tours]
13 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
14 CRMBM - Centre de résonance magnétique biologique et médicale
15 CEMEREM - Centre d'Exploration Métabolique par Résonance Magnétique [Hôpital de la Timone - APHM]
16 AMU - Aix Marseille Université
17 CNRS - Centre National de la Recherche Scientifique
18 CHU Rouen
19 CHU Nice - Centre Hospitalier Universitaire de Nice
20 HCL - Hospices Civils de Lyon
21 APHM - Assistance Publique - Hôpitaux de Marseille
22 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
23 UM - Université de Montpellier
24 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
25 Centre Hospitalier Henri Duffaut (Avignon)
26 CHU Caen
27 CHU Clermont-Ferrand
28 Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]
29 Centre Hospitalier Antibes - Juan-les-Pins
30 CH Epinal / CHED - Centre Hospitalier Emile Durkheim [Epinal]
31 CHU Bordeaux
32 CIC 1429 - Centre d’Investigation Clinique 1429 [Garches]
33 Clinique Francheville [Périgueux]
34 CHI Créteil
35 Centre Hospitalier de Saint-Denis [Ile-de-France]
36 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
37 CHU Limoges
38 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]

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.

Mots clés: Immuno-active treatment; Infections; Multiple sclerosis; Prevention

Domaines: Neurosciences [q-bio.NC]

Caroline Papeix, Cécile Donze, Christine Lebrun-Frénay, French Group For Recommendations In Multiple Sclerosis The Société Francophone de La Sclérose En Plaques, D. Laplaud, et al.. Infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society. Revue Neurologique, 2021, 177 (8), pp.980-994. ⟨10.1016/j.neurol.2021.04.011⟩. ⟨hal-03652381⟩