Safety profile of MS therapies
There are many drugs approved for the treatment of MS that lead to good
disease control and high patient adherence and compliance.
Unfortunately, however, these drugs are not free from serious adverse
reactions which in some cases are fatal. This is because there is little
data on safety on newer drugs such as ocrelizumab. Alemtuzumab was in
fact withdrawn from the market in Italy following serious adverse
reactions with CMV reactivation. The safety profile of INF and
glatiramer, on the other hand, has been evaluated in numerous studies,
the most frequent adverse reactions recorded being the symptoms of the
flu-like syndrome and the injection site reaction. This is why it is
considered the safest drug. Fingolimod leads to serious adverse rations
and the most common are infections, such as the urinary tract and lower
respiratory tract infections. Such reactions have been shown to be due
to the reduction of lymphocytes in the blood. The use of teriflunomide
and dimethyl fumarate shows that these drugs lead to a slight reduction
in the white blood cell count that could expose the patient to
infectious risk. The adverse events of ocrelizumab concern allergic
reactions for infusion, including itching, rash, urticaria and
hypoglobulinemia and lymphocytopenia associated with secondary
infections. Based on the present literature, post-marketing
pharmacovigilance data and product CPR, it is clear that there is an
increased risk of infection associated with drugs for MS. The marked
reduction in IgG and IgA leads to an increased risk of causing
infection, so the drugs for MS that cause a high reduction in IgG lead
to a marked risk of infection for the patient. Drugs such as Ocrelizumab
Cladribina should definitely be avoided because of their marked
lymphocytopenia (13-34).