医学
无症状的
多发性硬化
接种疫苗
进行性多灶性白质脑病
免疫学
抗体
儿科
内科学
作者
Stephanie Gandelman,Kerry Lenzi,Clyde Markowitz,Joseph R. Berger
出处
期刊:Neurology
[Ovid Technologies (Wolters Kluwer)]
日期:2024-02-01
卷期号:14 (1)
标识
DOI:10.1212/cpj.0000000000200241
摘要
BackgroundAnti-CD20 therapies have proven to be highly effective and safe therapies for multiple sclerosis (MS) and have had rapid uptake in the MS community. However, no clear consensus has arisen regarding an approach to screening or surveillance lab monitoring.Recent FindingsBased on current evidence, for screening labs before anti-CD20 initiation, we propose checking liver function test (LFT), complete blood count with differential (CBC), absolute B-cell count, quantitative immunoglobulins, hepatitis B virus serologies, varicella zoster virus IgG, John Cunningham virus (JCV) status, and age-appropriate vaccination history. For surveillance monitoring in an otherwise asymptomatic individual, we propose biannual LFTs and CBC, quantitative immunoglobulins annually after year 3, absolute B-cell count at month 6 and in the setting of relapse, and JCV only if clinical or radiographic features of progressive multifocal leukoencephalopathy arise. For ublituximab, pregnancy testing is additionally recommended before each infusion.Implications for PracticeWe propose evidence-based screening and safety surveillance labs which take into account likelihood of changing management in an otherwise stable or asymptomatic individual.
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