People with multiple sclerosis (MS) have compromised immune systems. Certain disease-modifying therapies (DMTs) used for treating MS may weaken and make changes to the immune system.

MS is an autoimmune condition in which the immune system attacks healthy cells and nerves around the body. People with MS have compromised immune systems, and have a higher risk of getting infections.

However, receiving certain types of treatment to manage the progression of the illness, such as DMTs, can also reduce the activity of the immune system. This may reduce the ability of the immune system to fight off infections and increase the risk of developing more severe illnesses.

This article will review whether MS causes a compromised immune system and the effects of being immunocompromised and having MS at the same time.

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Having MS does not automatically imply being immunocompromised, but most clinical practitioners regard those with MS as immunocompromised. However, some types of MS treatment, including DMTs, may alter the immune system and increase the risk of developing severe infections in certain groups of people.

DMTs are medications that suppress the inappropriate responses of the immune system to prevent it from attacking and damaging the brain and the spinal cord. DMTs can reduce the frequency of immune attacks and slow down the progression of MS.

The effect of DMTs can reduce the activity of the immune system. The suppression of the immune system may increase the risk of infections or developing severe illnesses.

Another type of MS treatment that may reduce the immune system’s efficacy is hematopoietic stem cell transplantation (HSCT). This treatment aims to stop MS from causing damage by eliminating and then regrowing the immune system of a person with this condition using their blood stem cells.

What is MS?

MS is the most common neurological disease occurring in young adults. Its onset typically occurs in people between 20 and 40 years of age.

In people with MS, the immune system incorrectly attacks the myelin, a substance that coats and protects the nerve fibers in the central nervous system, including the spinal cord, brain, and optic nerve.

MS is a chronic condition, and there is no cure for it. However, several treatment options are available for slowing down its progression. MS affects people differently. While certain individuals may have little to no disability, others can experience a steady and severe worsening of their conditions, causing increasing disability over time.

MS is unlikely to be fatal, and most people with this condition have a typical life expectancy. In most cases, people with MS alternate periods of partial or full recovery to flare-up periods during which they experience a worsening of their symptoms.

Having an immunocompromised immune system means that a person has a reduced ability to fight off diseases and infections as they have lowered immune system defenses. Immunocompromised people may also have a higher risk of getting infections.

This means that the immune system of immunocompromised people is less effective in dealing with bacterial, fungal, or viral infections. For this reason, people with an immunocompromised immune system may have a higher risk of developing serious illnesses or health complications, even due to simple infections.

A compromised immune system can occur due to several health conditions or as a side effect of certain medications, including:

MS can cause a generalized inflammation of the nervous system, causing a variety of symptoms. These may include:

  • Fatigue: About 80% of people with MS experience fatigue. This can make it difficult to perform daily activities at home and work.
  • Numbness and tingling: Numbness on the face, arms, legs, or body is typically one of the first symptoms of MS.
  • Weakness: MS can cause muscle weakness due to nerve damage and reduced muscle usage due to fatigue and other symptoms.
  • Spasticity: People can experience muscle stiffness and involuntary muscle contractions.
  • Vertigo and dizziness: People with MS may experience light-headedness or that their surroundings are spinning.
  • Pain and itching: MS can cause nerve pain or neuropathy and itching.
  • Walking difficulties: MS can make it difficult to walk due to the combination of its symptoms, such as muscle weakness, dizziness, and numbness of the lower limbs.
  • Vision issues: People with this condition may experience blurred vision, pain when moving the eyes, and poor contract or color vision. Vision issues can sometimes be one of the first symptoms people with MS notice.
  • Bladder and bowel troubles: About 80% of people with MS experience bladder problems, but this can typically be managed. MS may also cause constipation or loss of control of bowel movements.
  • Sexual problems: People may experience sexual dysfunctions due to nerve damage.
  • Cognitive changes: MS can lead to memory deterioration, making processing and learning new information difficult. People with MS may find it difficult to maintain focus or experience difficulties or reduced fluency when speaking.
  • Emotional changes and depression: The stress of living with MS and immune and neurologic changes may cause mood swings, irritability, anxiety, and depression. People may also experience outbreaks of uncontrollable laughing and crying.

People with certain autoimmune conditions, such as type 1 diabetes, may have a higher risk of developing other autoimmune conditions, including MS. Being immunocompromised alongside having MS may cause some challenges in finding the appropriate treatment to slow down the progression of MS.

A person with an underlying condition that causes the weakening of their immune system may not be able to receive DMTs, as these medications could further suppress the immune system and pose the person at risk of developing serious health complications in case of infection.

As people with MS undergoing DMT treatment usually have a higher risk of getting certain infections, doctors may recommend that they regularly receive vaccinations, such as flu shots, to protect them from the most common forms of infections.

People with MS can also take several steps to reduce the risk of infection, such as:

  • frequently washing their hands, in particular before eating
  • wearing a face mask in public and crowded places
  • avoiding people who have illnesses such as the flu

MS causes a compromised immune system. Certain MS medications, such as DMTs, can reduce the activity of the immune system, decreasing its ability to fight off infections.

People with MS who take DMT medications should try to manage the risks of getting infections, reducing the chance of developing any severe illnesses.