Table 2

Estimated risk of different disease-modifying treatments (DMTs) for infectious and non-infectious central nervous system adverse events in patients with multiple sclerosis

AlemtuzumabCladribineDimethylfumarateFingolimodGlatiramere acetateInterferon betaNatalizumabOcrelizumabTeriflunomide
JCV-associated diseases++++++±+++++
Herpesviruses+*–*+++*++++
Cryptococcus++++
Listeriosis++*++
Nocardiosis+
RCVS++
PRES+++
PCNSL+++
Cerebrovascular events†++
TDL++++
  • – no reported association; ± cases reported but link obscured because of comedication or comorbidity (eg, with carry-over progressive multifocal leukoencephalopathy); + only few case reports (<3 cases reported in literature); ++ several case reports or case series (>3 but <20 reported cases); +++ established but rare risk (>20 but <50 reported cases); ++++significant risk (>50 reported cases).,

  • Limitation: the DMTs listed substantially differ in overall exposure, as such long-term safety aspects may change over time in particular for newer DMTs such as cladribine with limited postmarketing experience.

  • *Risk may be minimised by institution of prophylactic therapy or vaccination,

  • †Cerebrovascular events include both ischaemic and haemorrhagic stroke, and cervical artery dissection.

  • JCV, JC virus; PCNSL, primary central nervous system lymphoma; PRES, posterior reversible encephalopathy syndrome; RCVS, reversible cerebral vasoconstriction syndrome; TDL, tumefactive demyelinating lesion.