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Which multiple sclerosis DMTs would you consider in patients with concurrent Crohn's disease and elevated JCV Ab titers?
Given the risks associated with using natalizumab (i.e., PML with high JCV Ab titers >1.5), rituximab (i.e., risk of IBD flare-ups), or the use of multiple immunosuppressive agents for each disease separately (e.g., recurrent infections), would you consider using agents such as azathioprine, mycophenolate or other immunosuppressants/steroid-sparing agents in managing both cases?
Answer from: at Academic Institution
This may depend on the course/activity of both the MS and Chron's. S1P inhibitors, specifically ozanimod, have minimal risk of PML and are FDA-approved for both UC/Chron's and MS. While the treatment landscape continues to shift, S1P inhibitors are generally considered either moderate or high-effica...
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