Neurol. praxi. 2025;26(3):206-210 | DOI: 10.36290/neu.2025.026

The impact of immunosupressive therapy on the immune system of a patient with multiple sclerosis

prof. MUDr. Mgr. Miloš Jeseňák, PhD., MBA, MHA, Dott.Ric., FAAAAI1, prof. MUDr. Jarmila Szilasiová, PhD.2
1 Ústav klinickej imunológie a lekárskej genetiky JLF UK a UNM v Martine
2 Neurologická klinika UPJŠ LF a UNLP Košice

Highly effective innovative immunotherapies for multiple sclerosis (MS) significantly improve the long-term prognosis of patients with MS. This immunointerventional treatment - DMT (Disease modifying therapy) affects various levels of immune proces­ses and can induce secondary immunodeficiency, mainly lymphopenia, by changing lymphocyte transport, their depletion and disruption of their replication. Immunosuppressive treatment of the disease can also lead to hypogammaglobulinemia and an increased risk of occurrence and worsening of the course of infections, to reactivation of latent pathogens and to worsening of asymptomatic chronic infections. In the article, we present an overview of the most common changes in immune responses during immunosuppressive treatment of multiple sclerosis, preventive strategies to minimize the risks of infections, especially by vaccination, which is a standard part of the managing patients with MS. In clinical practice, it is necessary to consider when and which vaccines to administer to the patient concerning his treatment of the underlying disease with preparations of the DMT group, which can affect vaccine reactions.

Keywords: multiple sclerosis, immune system, immunosuppressive therapy, lympho­penia, immunodeficiency, vaccination.

Received: February 13, 2025; Revised: February 13, 2025; Accepted: March 24, 2025; Published: July 4, 2025  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Jeseňák Dott. Ric. FAAAAI M, Szilasiová J. The impact of immunosupressive therapy on the immune system of a patient with multiple sclerosis. Neurol. praxi. 2025;26(3):206-210. doi: 10.36290/neu.2025.026.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Purchase PDF - 60 CZK (2.5 EUR)
    will be unlocked 4.7.2026

    References

    1. . Alvarez E, Longbrake EE, Rammohan KW, et al. Secondary hypogammaglobulinemia in patients with multiple sclerosis on anti-CD20 therapy: Pathogenesis, risk of infection, and disease management. Mult Scler Relat Disord. 2023;17,92:105917. doi: 10.1016/j.msard.2024.105917. Go to original source... Go to PubMed...
    2. . Andreson D, Ali K, Blanchette V, et al. Guidelines on the use of intravenous immune globulin for hematologic conditions. Transfus Med Rev. 2007;21(2 Suppl 1):S9-56 doi: 10.1016/j.tmrv.2007.01.001. Go to original source... Go to PubMed...
    3. . Arneth BM. Impact of B cells to the pathophysiology of multiple sclerosis. J Neuroinflammation. 2019;25;16(1):128. doi:10.1186/s12974-019-1517-1. Go to original source... Go to PubMed...
    4. . Bierhansl L, Hartung HP, Aktas O, et al. Thinking outside the box: non-canonical targets in multiple sclerosis. Nat Rev Drug Discov. 2022;21:578-600. doi:10.1038/s41573-022-00477-5. Go to original source... Go to PubMed...
    5. . Casulo C, Maragulia J, Zelenetz AD, et al. Incidence of hypogammaglobulinemia in patients receiving rituximab and the use of intravenous immunoglobulin for recurrent infections. Clin Lymphoma Myeloma Leuk. 2013;13(2):106-11. doi: 10.1016/j.clml.2012.11.011. Go to original source... Go to PubMed...
    6. . De Souza KJ, Ferro RS, Prestes-Carneiro LE, at al. Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab. Immunopharmacol Immunotoxicol. 2018;40(1):13-17. doi: 10.1080/08923973.2017.1392562. Go to original source... Go to PubMed...
    7. . Du Pasquier RA, Pinschewer DD, Merkleret D, et al. Immunological mechanism of action and clinical profile of disease-modifying treatments in multiple sclerosis. CNS Drugs. 2014;28(6):535-58. doi:10.1007/s40263-014-0160-8. Go to original source... Go to PubMed...
    8. . Elgenidy A, Abdelhalim NN, Al-Mahdi Al-Kurdi M, et al. Hypogammaglobulinemia and infections in patients with multiple sclerosis treated with anti-CD20 treatments: a systematic review and meta-analysis of 19,139 multiple sclerosis patients. Front Neurol. 2024;18:15:1380654. doi:10.3389/fneur.2024.1380654. eCollection 2024. Go to original source...
    9. . Fischer S, Proschmann U, Akgün K, et al. Lymphocyte counts and multiple sclerosis therapeutics: between mechanisms of action and treatment-limiting side effects cells. Cells. 2021;15;10(11):3177. doi: 0.3390/cells10113177. Go to original source... Go to PubMed...
    10. . Fox EJ, Buckle GJ, Singer B, et al. Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist. Neurol Clin Pract. 2019;9(1):53-63. doi: 10.1212/CPJ.0000000000000567. Go to original source... Go to PubMed...
    11. . Garbo R, Lorenzut S, Del Negro I, et al. Lower lymphocyte counts and older age are associated with reduced multiple sclerosis disease activity during dimethyl fumarate treatment. Mult Scler Relat Disord. 2021;49:102781. doi: 0.1016/j.msard.2021.102781. Go to original source... Go to PubMed...
    12. . Gharibi T, Babaloo Z, Hosseini A, et al. The role of B cells in the immunopathogenesis of multiple sclerosis. Immunology. 2020;160(4):325-335. doi:10.1111/imm.13198. Go to original source... Go to PubMed...
    13. . Ghaderi S, Berg-Hansen P, Bakken IJ, et al. Hospitalization following influenza infection and pandemic vaccination in multiple sclerosis patients: a nationwide population-based registry study from Norway. Eur J Epidemiol. 2020;35(4):355-362. doi:10.1007/s10654-019-00595-2. Go to original source... Go to PubMed...
    14. . Gudesblatt M, Gerber O, Vaillancourt PD, et al. Quasi-normal cerebrospinal fluid in patients with acquired immunodeficiency syndrome and cryptococcal meningitis. Rev Neurol (Paris). 1987;143(4):290-3.
    15. . Gunther G and Dreger B. Post-marketing observational study on 5% intravenous immunoglobulin therapy in patients with secondary immunodeficiency and recurrent serious bacterial infections Microbiol Immunol. 2013;57(7):527-35. doi:10.1111/1348-0421.12060. Go to original source... Go to PubMed...
    16. . Hauser SL, Bar-Or A, Comi G, Giovannoni G, OPERA I and OPERA II Clinical Investigators. Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis. N Engl J Med. 2017;19;376(3):221-234. doi:10.1056/NEJMoa1601277. Go to original source... Go to PubMed...
    17. . Chinen J, Shearer WT. Secondary immunodeficiencies, including HIV infection. J Allergy Clin Immunol. 2010 Feb;125(2 Suppl 2):S195-203. doi: 10.1016/j.jaci.2009.08.040. Go to original source... Go to PubMed...
    18. . Jakimovski D, Weinstock-Guttman B, Ramanathan M, et al. Infections, vaccines and autoimmunity: a multiple sclerosis perspective. Vaccines (Basel). 2020;28;8(1):50. doi: 10.3390/vaccines8010050. Go to original source... Go to PubMed...
    19. . Jeseňák M, Urbančíková I, et al. Očkovanie v špeciálnych situáciách. Praha: Mladá Fronta 2019. 478 ss.
    20. . Jolles S, Michallet M, Agostini C, et al. Treating secondary antibody deficiency in patients with haematological malignancy: European expert consensus. Eur J Haematol. 2021;106(4):439-449. doi:10.1111/ejh.13580. Go to original source... Go to PubMed...
    21. . Lapucci C, Boccia VD, Sirito T, et al. Safety of anti-varicella zoster virus vaccination in patients with multiple sclerosis treated with natalizumab: A case series. Mult Scler. 2023;29(11-12):1514-1517. doi:10.1177/13524585231204121. Go to original source... Go to PubMed...
    22. . Lebrun Ch, Vukusic S. Immunization and multiple sclerosis: Recommendations from the French multiple sclerosis society. Mult Scler Relat Disord. 2019;31:173-188. doi: 10.1016/j.msard.2019.04.004. Go to original source... Go to PubMed...
    23. . Metze Ch, Winkelmann A, Loebermann M, et al. Immunogenicity and predictors of response to a single dose trivalent seasonal influenza vaccine in multiple sclerosis patients receiving disease-modifying therapies. CNS Neurosci Ther. 2019;25(2):245-254. doi: 10.1111/cns.13034. Go to original source... Go to PubMed...
    24. . Oscier D, Dearden C, Eren E, et al. Guidelines on the diagnosis, investigation and management of chronic lymphocytic leukaemia. British Committee for Standards in Haematology. Br J Haematol. 2012;159(5):541-64. doi:10.1111/bjh.12067. Go to original source... Go to PubMed...
    25. . Oreja-Guevara C, Wiendl H, Kieseier BC, et al. NeuroNet Study Group. Specific aspects of modern life for people with multiple sclerosis: considerations for the practitioner. Ther Adv Neurol Disord. 2014;7(2):137-49. doi:10.1177/1756285613501575. Go to original source... Go to PubMed...
    26. . Otero-Romero S, Lebrun-Frénay Ch, Reyes S, et al. ECTRIMS/EAN consensus on vaccination in people with multiple sclerosis: improving immunization strateggies in the era of highly active immunotherapeutic drugs. Multiple Sclerosis Journal. 2023;29(8):904-925. Go to original source... Go to PubMed...
    27. . Papeix C, Mazoyer J, Maillart E, et al. Multiple sclerosis: Is there a risk of worsening after yellow fever vaccination? Mult Scler. 2021 Dec;27(14):2280-2283. doi: 10.1177/13524585211006372. Epub 2021 Apr 19. Go to original source... Go to PubMed...
    28. . Papp KA, Haraoui B, Kumar D, et al. Vaccination guidelines for patients with immune-mediated disorders on immunosuppressive therapies. J Cutan Med Surg. 2019;23(1):50-74. doi: 10.1177/1203475418811335. Go to original source... Go to PubMed...
    29. . Patel SY, Carbone J, Jolles S. The expanding field of secondary antibody deficiency: causes, diagnosis, and management. Front Immunol. 2019;10.33. doi. 10.3389/fimmu.2019.00033. eCollection 2019. Go to original source... Go to PubMed...
    30. . Perez E, Orange JS, Bonilla F, et al. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol. 2017;139(3S):S1-46. doi: 10.1016/j.jaci.2016.09.023. Go to original source... Go to PubMed...
    31. . Perez E, Bokszczanin A, McDonald-McGinn D, et al. Safety of live viral vaccines in patients with chromosome 22q11.2 deletion syndrome (DiGeorge syndrome/ velocardiofacial syndrome). Pediatrics. 2003;112(4):e325. doi:10.1542/peds.112.4.e325. Go to original source... Go to PubMed...
    32. . Pikor N, Gommerman JL. B cells in MS: Why, where and how? Mult Scler Relat Dis. 2012;1(3):123-30. doi:10.1016/j.msard.2012.03.006. Go to original source... Go to PubMed...
    33. . Principi N, Esposito S. Vaccine use in primary immunodeficiency disorders. Vaccine. 2014;32(30):3725-31. doi:10.1016/j.vaccine.2014.05.022. Go to original source... Go to PubMed...
    34. . Rapisarda L, Valentino P, Barone S, et al. Varicella zoster immunity loss in multiple sclerosis patient treated with ocrelizumab. Clin Immunol. 2021;223:108554. doi: 10.1016/j.clim.2020.108554. Go to original source... Go to PubMed...
    35. . Súhrn charakteristických vlastností lieku Gilenya, Tecfidera, Lemtrada, Aubagio, Tysabri, Ocrevus, Kesimpta. Dostupné na: www.sukl.sk.
    36. . Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective. Preface. Bone Marrow Transplant. 2009;44(8):453-455. doi:10.1038/bmt.2009.254. Go to original source... Go to PubMed...
    37. . Tuano KS. Seth N, Chinen J. Secondary immunodeficiencies: An overview. Ann Allergy Asthma Immunol. 2021;127(6):617-626. doi:10.1016/j.anai.2021.08.413. Go to original source... Go to PubMed...
    38. . Van Langelaar J, Rijvers L, Janssen M, et al. Induction of brain-infiltrating T-bet-expressing B cells in multiple sclerosis. Ann Neurol. 2019;86(2):264-278. doi:10.1002/ana.25508. Go to original source... Go to PubMed...
    39. . Williamson EML, Chahin S, Berger JR. Vaccines in Multiple Sclerosis. Curr Neurol Neurosci Rep. 2016;16(4):36. doi:10.1007/s11910-016-0637-6. Go to original source... Go to PubMed...
    40. . Zrzavy T, Kollaritsch H, Rommer PS. Vaccination in Multiple Sclerosis: Friend or Foe? Front Immunol. 2019;10:1883. doi:10.3389/fimmu.2019.01883. eCollection 2019. Go to original source...

    Return to the content


    Neurology for Practice

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.