How do we manage and treat a patient with multiple sclerosis at risk of tuberculosis?

Abstract

Tuberculosis continues to be a serious health problem worldwide. The disease continues to be underdiagnosed and not properly treated. In conditions that affect the immune system, such as multiple sclerosis (MS), latent tuberculosis may thrive and reactivate during the use of immunomodulatory and immunosuppressive drugs. Among the best treatment options for patients with latent or active tuberculosis who have MS are IFN-β, glatiramer acetate and mitoxantrone. Drugs leading to a reduced number and/or function of lymphocytes should be avoided or used with caution. Tuberculosis must always be investigated in patients with MS and treated with rigor.

Keywords::

• fingolimod
• fumarate
• glatiramer acetate
• IFN-β
• multiple sclerosis
• natalizumab
• teriflunomide
• tuberculosis

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Tuberculosis and multiple sclerosis (MS) are severe diseases that are increasing worldwide, affecting mainly young adults.

• Drugs used for the treatment of MS are immunomodulatory and/or immunosuppressive. Therefore, these drugs may facilitate the reactivation of tuberculosis.

• Investigation and treatment of active or latent tuberculosis should be considered for all patients undergoing treatment of MS. Despite the idea that tuberculosis is a disease of the underdeveloped world and MS is a disease of developed countries, this cannot be held true for the global situation we live in the 21 century.

• Immunosuppressive drugs should be avoided in patients at risk of tuberculosis. The risk should be tested more than only at the institution of a new therapy.

• The safest drugs to be used in patients with latent tuberculosis are IFN-β, glatiramer acetate and mitoxantrone.