Varicella zoster-associated acute retinal necrosis and central nervous system complications in natalizumab treated MS patients

Kempen, Zoé L E van; Rossum, J.A. van; Hoogervorst, Erwin L.J.; Strijbis, Eva; Toorop, Alyssa A; Bosscha, Machteld I.; Frequin, S.T.F.M.; Loon, Ninette ten Dam-van; Wattjes, Mike P.; Murk, Jean-Luc; Killestein, Joep; Uitdehaag, Bernard M. J.

doi:10.1016/j.msard.2021.102838

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…10 Furthermore, VZV-associated CNS infections/vasculitis and retinal complications in MS patients during NTZ treatment have been described, and this may represent a further indication in favour of VZV vaccination. 11 To the best of our knowledge, no cases of VZV vaccineinduced disease have been described so far. Miauton et al 12 reported the first case of possible vaccineassociated measles in a patient treated with NTZ with favourable outcome although the lack of the measles strain typing could not exclude a wild-type measles infection.…”

Section: Discussionmentioning

confidence: 99%

Safety of anti-varicella zoster virus vaccination in patients with multiple sclerosis treated with natalizumab: A case series

Lapucci,

Boccia,

Sirito

et al. 2023

Mult Scler

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The vaccination with live attenuated vaccines is generally not recommended during natalizumab (NTZ), as it is included among immunosuppressive/immunomodulating therapies. Nevertheless, considering the lack of evidence of a non-Central Nervous System (CNS) immunosuppressive effect of NTZ, after a risk/benefit evaluation, we decided to vaccinate four multiple sclerosis (MS) patients (three with an indication to switch to ocrelizumab for high-risk Progressive Multifocal Leukoencephalopathy (PML) and one for pregnancy planning). No vaccine-related adverse events of any type nor varicella zoster virus (VZV) infections were observed. To the best of our knowledge, these case series represent the first description of the good safety profile of anti-VZV vaccination in MS patients during NTZ treatment.

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Section: Discussionmentioning

confidence: 99%

Safety of anti-varicella zoster virus vaccination in patients with multiple sclerosis treated with natalizumab: A case series

Lapucci,

Boccia,

Sirito

et al. 2023

Mult Scler

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“…There are no controlled trials that have assessed the optimal treatment strategy for patients with intracerebral VZV vasculopathy. Due to the scarcity of cases of herpes virus infections in MS patients, larger studies defining susceptibility to neurotropic viruses during different treatments are also missing 7 23. Therefore, there are no current guidelines considering treatment of intracerebral VZV vasculopathy, nor the management of immunomodulating treatment after an episode of VZV vasculopathy.…”

Section: Discussionmentioning

confidence: 99%

Varicella-zoster virus vasculopathy in a patient with multiple sclerosis receiving natalizumab

Elmståhl,

Buchwald,

Ilinca

2023

BMJ Case Rep

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We present a case of a woman in her 30s with relapsing-remitting multiple sclerosis, treated with natalizumab, who developed ophthalmic varicella zoster virus (VZV) infection, with subsequent vasculopathy causing cerebral ischaemic lesions. She was treated with acyclovir, prednisolone and acetylsalicylic acid and fully recovered. VZV vasculopathy is associated with stroke and immunomodulating treatments may increase the risks of these adverse events. To date, nine VZV-related vasculopathy cases in patients treated with natalizumab have been reported in English literature and are summarised in this paper. Although rare, VZV intracerebral vasculopathy is an important differential diagnosis in patients with unexplained new-onset neurological symptoms after a herpes zoster infection. Treatment guidelines for VZV vasculopathy and for continuing treatment of multiple sclerosis after such an event are currently not established.

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“…Importantly, natalizumab has also been associated with other infections, not only JCV-associated PML, such as meningovasculitis 95 or retinitis, 96 both in the context of VZV infection and herpes simplex encephalitis. 97 Table 2 shows the main risk mitigation strategies in relation to PML (and other infectious risks)…”

Section: Infections Associated With Disease-modifying Treatmentsmentioning

confidence: 99%

The risk of infections for multiple sclerosis and neuromyelitis optica spectrum disorder disease-modifying treatments: Eighth European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop Review. April 2021

et al. 2022

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Over the recent years, the treatment of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) has evolved very rapidly and a large number of disease-modifying treatments (DMTs) are now available. However, most DMTs are associated with adverse events, the most frequent of which being infections. Consideration of all DMT-associated risks facilitates development of risk mitigation strategies. An international focused workshop with expert-led discussions was sponsored by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and was held in April 2021 to review our current knowledge about the risk of infections associated with the use of DMTs for people with MS and NMOSD and corresponding risk mitigation strategies. The workshop addressed DMT-associated infections in specific populations, such as children and pregnant women with MS, or people with MS who have other comorbidities or live in regions with an exceptionally high infection burden. Finally, we reviewed the topic of DMT-associated infectious risks in the context of the current SARS-CoV-2 pandemic. Herein, we summarize available evidence and identify gaps in knowledge which justify further research.

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Varicella zoster-associated acute retinal necrosis and central nervous system complications in natalizumab treated MS patients

Cited by 11 publications

References 13 publications

Safety of anti-varicella zoster virus vaccination in patients with multiple sclerosis treated with natalizumab: A case series

Safety of anti-varicella zoster virus vaccination in patients with multiple sclerosis treated with natalizumab: A case series

Varicella-zoster virus vasculopathy in a patient with multiple sclerosis receiving natalizumab

The risk of infections for multiple sclerosis and neuromyelitis optica spectrum disorder disease-modifying treatments: Eighth European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop Review. April 2021

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