Infection studies in registry-based MS research
ECTRIMS Online Library. Montgomery S. Sep 13, 2019; 279533; 270
Scott Montgomery
Scott Montgomery

Abstract: 270

Type: Scientific Session

Abstract Category: Scientific Session 11: Registry-based MS research

S. Montgomery

Karolinska Insitutet, Stockholm, Sweden

The risk of serious infections in MS patients is influenced both by use of some treatments and by the disease itself. Swedish registers may be used to characterise the patients at greatest risk of serious infections, defined as infections that are fatal or require admission to hospital thus facilitating more effective management. Using a cohort of 29,617 MS patients matched with 296,164 without MS, risks for serious infections were investigated. These include treatment, MS disease characteristics and history of infections, including antibiotic use. This will include infections prior to MS diagnosis, to signal greater susceptibility to infection. Infections may also represent a risk for MS, although there has been debate about whether infections are causally related or signal greater MS susceptibility. We hypothesise that inflammation of the lungs may represent a risk for MS, as T-cells passing through the lungs can be licenced to enter the central nervous system. As pneumonia can result in significant persisting inflammation, we examined the association of this infection in childhood and adolescence with subsequent MS among 6,109 with MS and 49,479 without. Pneumonia infections between ages 11-15 years, but not earlier in childhood, were associated with MS, producing an adds ratio (and 95% confidence intervals) of 1.97 (1.21-3.23). To investigate whether infectious mononucleosis represents a causal risk for MS, a within-sibling design was used, such that the risk of MS among siblings discordant for infectious mononucleosis is investigated to take into account unmeasured familial confounding by genetic and environmental factors. Using a general population cohort of 3.2 million individuals born in Sweden between 1970 and 2000, conventional Cox regression analysis produced a hazard ratio for MS associated with infectious mononucleosis in adolescence of 2.54 (1.77-3.65). Within-sibling analysis produced a similar estimate of 2.83 (1.36-5.88), consistent with a causal interpretation. Infections influence both risk of MS and represent serious outcomes that may be predicted using clinical characteristics.
Disclosure: Research funding from Novartis, Roche, Astrazeneca and IQVIA. Speaker´s fee from Teva.

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