Infusional therapies in multiple sclerosis and neuromyelitis optica: long-term experience from a specialized neurological infusional therapy center from a university hospital in Rio de Janeiro

Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorders (NMOSD) are autoimmune disorders that affect the central nervous system (CNS). Infusional intravenous (IV) therapies have been used successfully for treatment of relapses and as disease-modifying drugs for both conditions. Our aim is to demonstrate the infusional therapies experience in MS and NMOSD from a specialized neurological infusional center in Hospital Universitário Pedro Ernesto (HUPE) in Rio de Janeiro. From June 2016 to April 2024, 4510 infusions were registered in the medical electronic chart from 341 patients. Each patient is consulted by a physician and evaluated by nursing staff experienced prior to each infusion. One-hundred and nine (109/341, 31,9%) patients were on Natalizumab (NTZ), 35 (10,26%) on Rituximab (RTX), 31(9%) Fingolimod (FTY) first-doses, 16 (4,7%) on Ocrelizumab (OCR), 2 (0,58%) on Alemtuzumab, and 1 (0,29%) on Eculizumab (ECU). Intravenous methylprednisolone (IVMP) and intravenous human immunoglobulin (IVIg), mostly used for treatment of attacks, account for the remaining infusions. The most common adverse events reported in our center were, by treatment: a. NTZ: 4 patients - headache (4/109: 3,6%); 2 patients - pruritus (2/109, 1,83%) b. RTX: three patients: pharyngeal pruritus, headache, nausea, vomiting, agitation (1/33; 0,03%); sinus tachycardia (1/35; 0,03% ); bronchospasm (1/35; 0,03%) , c.FTY: asymptomatic prolonged bradycardia (1/31, 0,03%) , d. OCR: allergic rash (2/16; 0,125%), e. Alemtuzumab: allergic rash (2/2,100%); f. ECU: none (0%). No deaths occurred during the observation period. Natalizumab was the most prevalent infusional therapy in our center. Long-term data from our center shows that the majority of DMTs are safe when administered by trained and experienced medical and nursing staff. Most of the adverse events were mild and did not require interruption of treatment.