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Background: Treatment of multiple sclerosis (MS) with delayed-release dimethyl fumarate (DMF) has shown efficacy and safety in clinical trials. However, the occurrence of infectious complications, particularly in elderly patients, remains a concern., Methods: We present the case of a 63-year-old woman with late-onset MS treated with DMF, who developed a severe primary cytomegalovirus (CMV) infection. DMF was discontinued, and antiviral treatment was initiated, resulting in complete resolution of symptoms., Results: While DMF is generally considered safe in terms of opportunistic infections, this case highlights the possibility of serious infectious complications in eldery DMF-treated patients, even without documented lymphopenia., Conclusion: Advanced age and the associated immunological changes may contribute to an inadequate immune response to MS treatments, highlighting the importance of a careful treatment choice in elderly patients with MS. Further research and specific data on the safety and efficacy of DMF in this population are required to guide clinical decision-making., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Muñoz, Santiago, Escudero and Merino.)

Background: The increase in available disease modifying therapies (DMTs) for multiple sclerosis has led to greater emphasis on improving treatment sequencing paradigms. This article summarises the opinions from a panel of 25 experts on treatment switching approaches in relapsing multiple sclerosis (RMS)., Methods: A modified Delphi consensus process was carried out to develop clinically relevant statements for aiding treatment decisions in patients with RMS between the 16 th January and the 9 th October 2019. A sub-group of two experts (core group) carried out an extensive review of the literature and formulated 106 statements for the expert panel to evaluate., Results: From a total number of 106 statements that were submitted to the expert panel for critical evaluation, consensus (at least 80% of the panelists agreed) was reached on 99 of them. These statements cover treatment objectives, reasons for DMT switching, suboptimal response criteria, strategies for treatment change and washout periods., Conclusion: The agreed statements provide up-to-date guidance on DMT sequencing for optimal patient management., (Copyright © 2022. Published by Elsevier B.V.)