Alemtuzumab – Pre-Treatment Infection Screening — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationAlemtuzumab – Pre-Treatment Infection ScreeningSCE Neurology

A 45-year-old woman with newly diagnosed RRMS has high lesion load (>9 T2 lesions), 3 enhancing lesions, and a spinal cord lesion. She has had 2 severe relapses in 6 months. Her neurologist recommends early high-efficacy treatment with alemtuzumab. Before starting, which infections must be screened for?

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Correct answer: B — Varicella zoster (VZV IgG), hepatitis B and C, HIV, tuberculosis (IGRA/Mantoux), and syphilis

Explanation lettering: E = shown as A · A = shown as C · C = shown as E

Before starting alemtuzumab (and other potent immunosuppressive DMTs), comprehensive infection screening is mandatory: VZV serology (vaccinate if non-immune before starting), hepatitis B surface antigen and core antibody (risk of reactivation), hepatitis C antibody, HIV serology, tuberculosis screening (IGRA or Mantoux — risk of reactivation), and syphilis serology. This screening protocol applies broadly to all high-efficacy DMTs (alemtuzumab, ocrelizumab, cladribine). Cervical screening and baseline bloods (FBC, LFTs, renal, thyroid) are also required. A: Screening is mandatory. C/D/E: All listed infections require screening.

Reference: NICE TA312 Alemtuzumab; Alemtuzumab SmPC; ABN MS Guidelines (2022)