NEUROLOGIE PRO PRAXI / Neurol. praxi. 2025;26(3):206-210 / www.neurologiepropraxi.cz 210 HLAVNÍ TÉMA Dopad imunosupresívnej liečby na imunitný systém pacienta s roztrúsenou sklerózou kej oblasti, je nevyhnutné zvážiť pomer rizika a benefitu a pristupovať v tejto otázke vysoko individuálne. V tabuľke 4 je uvedená schéma odporúčaných postupov pri očkovaní živými vakcínami vo vzťahu k DMT liečbe u pacientov s RS (Ghaderi et al., 2019; Williamson et al., 2016; Lebrun et al., 2019; Zrzavy et al., 2019; Rapisarda et al., 2021; Lapucci et al., 2023; Jakimovski et al., 2020; Metze et al., 2018; Jeseňák et al., 2019; Williamson, 2016; Oreja-Guevara et al., 2014; Otero-Romero et al., 2023; www.sukl.sk). Pri zvažovaní možnosti očkovania živými atenuovanými vakcínami je potrebné zhodnotiť parametre celulárnej imunity. U dospelých by mali byť počty CD4+ T lymfocytov ≥ 500/μl (miernejšie kritériá udávajú ≥ 200/μl) a počty CD8+ T lymfocytov ≥ 200/μl (McFarland, 1999; Papp et al., 2018; Perez et al., 2003; Principi et al., 2014). Záver U pacientov s RS môže viesť imunosupresívna liečba ochorenia k lymfopénii, hypogamaglobulinémii a zvýšenému riziku výskytu a zhoršenému priebehu infekcií. Neurológ v spolupráci s imunológom využíva postupy preventívnych stratégií na minimalizáciu rizík infekcií predovšetkým očkovaním. Očkovanie je štandardnou súčasťou manažmentu pacientov s RS. V klinickej praxi je potrebné zvážiť, kedy a ktoré vakcíny podať pacientovi vzhľadom na jeho liečbu základného ochorenia preparátmi skupiny DMT, ktoré môžu ovplyvniť reakcie na vakcínu. LITERATÚRA 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. 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