Tuberculosis Common in MS Treated With Immunosuppressive Agents

Tuberculosis, x-ray
Tuberculosis, x-ray
Immunotherapy in multiple sclerosis may increase the risk for conversion from latent to active tuberculosis infection.
The following article is part of conference coverage from the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers in Nashville, Tennesssee. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from CMSC 2018.

According to a study presented at the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 30-June 2 in Nashville, Tennessee, researchers from the Beth Israel Deaconess Medical Center in Boston, Massachusetts, report that latent tuberculosis (TB) infection is relatively common in patients with multiple sclerosis (MS), and patients should be screened for TB prior to initiating immunosuppressive agents.

“Up to 13 million people have LTBIs [latent TB infections] in the United States, [and] patients with a compromised immune system are at risk for converting from LTBI to active tuberculosis infection,” the researchers explained. “Immunomodulatory therapies for [MS] may put individuals with LTBI at higher risk of developing active tuberculosis. The QuantiFERON-TB Gold In-Tube (QFT-GIT) assay measures the release of interferon gamma (IFNγ) to detect LTBI.”

A total of 212 patients from the Beth Israel Deaconess Medical Center’s MS Center underwent screening for LTBI, with laboratory data used to determine the association between infection risk and use of immunosuppressive agents. Investigators conducted screening for TB using the QFT-GIT assay during routine testing. All patients were tested for LTBI before starting or while receiving immunomodulating therapy.

Only 1.4% (n=3) of patients in the study tested positive for LTBI, with 2 of the patients having no discernible risk factors for the infection. Indeterminate assay results were found in 13.7% (n=29) of patients, and 75.9% (n=22) of these patients were receiving treatment with dimethyl fumarate. Indeterminate assay results were reported for 1 patient receiving treatment with intravenous methylprednisolone, one patient receiving treatment with fingolimod, and 5 patients who were not receiving any immunomodulatory therapy. Significant factors associated with indeterminate assay results included use of dimethyl fumarate; presence of lymphocytopenia; decreased absolute lymphocyte count; decreased CD3, CD4, and CD8 counts; and an increased CD4/CD8 ratio (P <.001).

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“Screening for LTBI prior to starting immunosuppressive agents for MS could help prevent activation of [TB],” the researchers added. “Dimethyl fumarate appears to preferentially reduce both CD8 counts and CD8 function as measured by the IFNγ release via the QFT-GIT assay.”

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Bouley AJ, Baber U, Egnor E, Sloane JA. Screening for tuberculosis in an outpatient population of multiple sclerosis. Presented at: 32nd Annual Meeting of the Consortium of Multiple Sclerosis Centers. May 30-June 2, 2018; Nashville, TN. Abstract NI04.