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Semin Neurol 2014; 34(04): 467-478
DOI: 10.1055/s-0034-1390395
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Neurologist's Guide to Safe Use of Immunomodulatory Therapies

Ivana Vodopivec
1   Harvard Medical School, Boston, Massachusetts
2   Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
,
Eli M. Miloslavsky
1   Harvard Medical School, Boston, Massachusetts
3   Rheumatology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
,
Camille N. Kotton
1   Harvard Medical School, Boston, Massachusetts
4   Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
,
Tracey A. Cho
1   Harvard Medical School, Boston, Massachusetts
2   Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
04 November 2014 (online)

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Abstract

Increased understanding of the pathogenesis of immune-mediated neurologic conditions with concomitant development of new therapeutic agents modulating various aspects of the immune system has resulted in the use of innovative therapies in the treatment of these diseases. These novel immunomodulatory therapeutic regimens also augment the potential for complications, including severe adverse effects.

In this review, the authors address practical issues regarding management of patients with neuroimmunological conditions treated with immunomodulatory therapies, including glucocorticoids, methotrexate, azathioprine, mycophenolate, cyclophosphamide, rituximab, tumor necrosis factor-α inhibitors, and intravenous immunoglobulins. Particular focus is placed on their infectious and noninfectious adverse effects, contraindications, safety monitoring, risk surveillance, and preventive strategies in clinical practice.

Keywords

immunosuppressive drugs - intravenous immunoglobulin - safety - infection - vaccination - glucocorticoid-induced osteoporosis - infertility - malignancy
 

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