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Objective To investigate the association between infections and disability worsening in people with multiple sclerosis (MS) treated with either B‐cell depleting therapy (rituximab) or interferon‐beta/glatiramer acetate (IFN/GA). Methods This cohort study spanned from 2000 to 2021, using data from the Swedish MS Registry linked to national health care registries, comprising 8,759 rituximab and 7,561 IFN/GA treatment episodes. The risk of hospital‐treated infection was estimated using multivariable Cox models. The association between infections and increase in Expanded Disability Status Scale (EDSS) scores was assessed using a doubly robust generalized estimating equations model. Additionally, a piece‐wise exponential model analyzed events of increased disability beyond defined cut‐off values, controlling for relapses, and MRI activity. Results Compared with IFN/GA, rituximab displayed increased risk of both inpatient‐ and outpatient‐treated infections (hazard ratio HR, 2.08; 95% confidence interval CI, 1.50–2.90 and HR, 1.37; 95% CI, 1.13–1.67, respectively). An inpatient‐treated infection was associated with a 0.19‐unit increase in EDSS (95% CI, 0.12–0.26). Degree of worsening was greatest for progressive MS, and under IFN/GA treatment, which unlike rituximab, was more commonly associated with MRI activity. After controlling for relapses and MRI activity, inpatient‐treated infections were associated with disability worsening in people with relapsing–remitting MS treated with IFN/GA (HR, 2.01; 95% CI, 1.59–2.53), but not in those treated with rituximab. Interpretation Compared to IFN/GA, rituximab doubled the infection risk, but reduced the risk of subsequent disability worsening. Further, the risk of worsening after hospital‐treated infection was greater with progressive MS than with relapsing–remitting MS. Infection risk should be considered to improve long term outcomes. ANN NEUROL 2024;96:694–703
Hu et al. (Wed,) studied this question.