{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T07:16:16Z","timestamp":1793776576119,"version":"4.6.1"},"reference-count":58,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2018,7,16]],"date-time":"2018-07-16T00:00:00Z","timestamp":1531699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Multiple sclerosis therapies include interferons, glatiramer, and multiple immunosuppressive drugs. Discerning infectious risks of immunosuppressive drugs requires understanding their mechanisms of action and analyzing interventional studies and postmarketing observational data. Though identical immunosuppressive therapies are sometimes used in non-neurologic conditions, infectious risks may differ in this population. Screening for and treatment of latent tuberculosis (TB) infection should be prioritized for patients receiving alemtuzumab; ocrelizumab is likely not associated with an increased risk of TB. Hepatitis B virus (HBV) reactivation can be devastating for patients treated with ocrelizumab and alemtuzumab, whereas the small molecule oral agents do not likely pose substantial risk of HBV. Progressive multifocal leukoencephalopathy is a particular concern with natalizumab. Alemtuzumab, and possibly natalizumab and fingolimod, risks herpes virus reactivation and may warrant prophylaxis. Unusual opportunistic infections have been described. Vaccination is an important tool in preventing infections, though vaccine timing and contraindications can be complex.<\/jats:p>","DOI":"10.1093\/ofid\/ofy174","type":"journal-article","created":{"date-parts":[[2018,7,16]],"date-time":"2018-07-16T05:31:20Z","timestamp":1531719080000},"source":"Crossref","is-referenced-by-count":131,"title":["Infectious Complications of Multiple Sclerosis Therapies: Implications for Screening, Prophylaxis, and Management"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8541-2623","authenticated-orcid":false,"given":"David J","family":"Epstein","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurological Sciences, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stan","family":"Deresinski","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,7,16]]},"reference":[{"key":"2020081004293049200_CIT0001","volume-title":"MS drug Daclizumab (zinbryta) pulled from the market","author":"Brooks"},{"key":"2020081004293049200_CIT0002","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1016\/S0140-6736(18)30475-6","article-title":"Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study","volume":"391","author":"Kappos","year":"2018","journal-title":"Lancet"},{"key":"2020081004293049200_CIT0003","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1056\/NEJMoa044396","volume":"354","author":"Rudick","year":"2006","journal-title":"N Engl J Med"},{"key":"2020081004293049200_CIT0004","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1002\/ana.21867","article-title":"Rituximab in patients with primary progressive multiple sclerosis: results of a randomized double-blind placebo-controlled multicenter trial","volume":"66","author":"Hawker","year":"2009","journal-title":"Ann Neurol"},{"key":"2020081004293049200_CIT0005","doi-asserted-by":"crossref","first-page":"e0153217","DOI":"10.1371\/journal.pone.0153217","article-title":"Different risk of tuberculosis and efficacy of isoniazid prophylaxis in rheumatoid arthritis patients with biologic therapy: a nationwide retrospective cohort study in Taiwan","volume":"11","author":"Liao","year":"2016","journal-title":"PLoS One"},{"key":"2020081004293049200_CIT0006","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s00277-009-0806-7","article-title":"Reactivation of hepatitis B virus following rituximab-based regimens: a serious complication in both HBsAg-positive and HBsAg-negative patients","volume":"89","author":"Pei","year":"2010","journal-title":"Ann Hematol"},{"key":"2020081004293049200_CIT0007","volume-title":"Division of Tuberculosis Elimination. 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