How do you navigate conversations with patients who are reluctant to start high-efficacy DMTs due to infection risk?

Prescribing and changing DMTs involves shared decision-making and patient education. I fall into the large group of MS specialists who use high-efficacy DMTs for many of my patients at early stages of the disease, as well as in patients with signs of progressive disease. One of the concerns about DM...

Infection risk is overblown and possibly related to Rituxan-mediated literature. As well, prolonged use of the anti-CD20 DMTs is generally thought to be associated with a lowering of serum immunoglobulins. And yes, infections can be a risk, as well as hospitalizations from severe infections, but I a...

This is a common issue that we run into in clinic when discussing DMT choice for both pediatric and adult patients. The infection risk depends on the DMT in question. In general, the lower-efficacy DMTs carry lower infection risks, and the higher-efficacy DMTs (e.g., B-cell depleting therapies, nata...

The central message is that the choice is not between treatment and “no risk,” but between the risks of therapy and the risks of inadequately treated MS. Active MS can cause irreversible disability, and disability itself increases infection risk through impaired mobility, bladder dysfunction, dyspha...

I usually frame the discussion around the balance between the risk of infection and the risk of undertreating MS. In younger patients with relapsing MS, particularly those with active disease or other features associated with a higher risk of future disability, I favor early use of high-efficacy the...