Factors associated with dimethyl fumarate-induced lymphopenia.
J Neurol Sci
; 398: 4-8, 2019 Mar 15.
Article
in En
| MEDLINE
| ID: mdl-30658226
ABSTRACT
BACKGROUND:
Lymphopenia is a major concern in MS patients treated with dimethyl-fumarate (DMF) as it increases the risk of progressive multifocal leukoencephalopathy.OBJECTIVE:
To identify factors associated with lymphopenia in DMF-treated patients and explore changes in blood lymphocyte subsets associated with DMF-induced lymphopenia.METHODS:
Prospective longitudinal study including 106 patients initiating DMF treatment followed for a median time of 24.67â¯months. Blood lymphocyte subsets were studied in 64 patients by flow cytometry at baseline and 6â¯months after.RESULTS:
Mean absolute lymphocyte counts (ALCs) decreased by 29% during the first year of DMF-treatment. Patients developing lymphopenia showed a faster decline within the three first months. A reduction of ALCs higher than 38% at this time was associated to subsequent development of grade 2-3 lymphopenia (ORâ¯=â¯5.93, 95% CI 1.9-18.6, pâ¯=â¯0.002). All patients showed a significant decrease in different T and B lymphocyte subsets upon DMF therapy. In addition, lymphopenic patients experienced a selective decrease in natural killer T (NKT) cell percentages (pâ¯=â¯0.01), and a high drop in NKT total counts (pâ¯<â¯0.0001).CONCLUSIONS:
Patients who experience a drop in ALCs by >38% at three months of DMF-treatment are about 6-times more likely to develop significant lymphopenia. This decrease is clearly associated with a considerable loss of NKT cells.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Lymphocytes
/
Dimethyl Fumarate
/
Immunosuppressive Agents
/
Lymphopenia
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Neurol Sci
Year:
2019
Document type:
Article