Clinical opinions and case studies on understanding and managing hypogammaglobulinaemia in multiple sclerosis: United Kingdom perspective

Abstract

BACKGROUND: Immunomodulatory disease-modifying therapies (DMTs) in multiple sclerosis (MS) have implications for secondary immunological effects and immunodeficiencies such as hypogammaglobulinaemia and reductions in immunoglobulin levels. Neurologists and treating healthcare professionals should be aware of hypogammaglobulinaemia and be able to manage resulting complications appropriately. METHODS: This paper draws on brief clinical case studies in the United Kingdom to illustrate aspects of immunomodulatory DMTs in MS and aims to inform and increase understanding of the role of immunoglobulins in MS, including the presentation of reduced immunoglobulin levels and the interpretation of haematological parameters. RESULTS AND CONCLUSIONS: Hypogammaglobulinaemia and prolonged or substantial reductions in immunoglobulin levels carry clinical implications for people living with MS. UK healthcare professionals working in MS can learn from other immunological specialities concerning the management of infection, vaccination, immunisation and treatment with different DMTs. They should be aware of how hypogammaglobulinaemia in MS presents and how to manage this in the context of DMTs, including the interpretation of haematological parameters and safety.