Delayed and recurrent dimethyl fumarate induced-lymphopenia in patients with multiple sclerosis.

Details

Serval ID
serval:BIB_356C04602C66
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Delayed and recurrent dimethyl fumarate induced-lymphopenia in patients with multiple sclerosis.
Journal
Multiple sclerosis and related disorders
Author(s)
Borrelli S., Mathias A., Goff G.L., Pasquier R.D., Théaudin M., Pot C.
ISSN
2211-0356 (Electronic)
ISSN-L
2211-0348
Publication state
Published
Issued date
07/2022
Peer-reviewed
Oui
Volume
63
Pages
103887
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
Early lymphopenia is a known side effect of dimethyl fumarate, a disease-modifying therapy for MS. However, the long-term effects on immune response and the impact on lymphocyte counts when another disease-modifying treatment is introduced, remain unknown. To better understand these specific aspects, we reviewed cases that develop prolonged grade 2 to 4 lymphopenia under dimethyl fumarate in Lausanne MS clinic.
Retrospective analysis of the 12 patients (10.1%) who discontinued dimethyl fumarate because of prolonged lymphopenia amongst the 119 patients treated with dimethyl fumarate. We reviewed their demographics, as well as their clinical, biological and MRI characteristics compared to the non-lymphopenic patients, during dimethyl fumarate therapy, and within a timeframe of up to 18 months after switching to another disease-modifying treatment. We also focused on lymphocyte subsets in a subgroup of patients.
Compared to non-lymphopenic patients, lymphopenic patients were older at dimethyl fumarate initiation (51.4 yo vs 39.7, p = 0.0003) and the majority were male (p = 0.037). Three of them (25%) developed delayed lymphopenia, more than one year after treatment onset. Despite persistent lymphopenia, three patients experienced disease activity. Amongst the nine patients (75%) who were switched to another therapy, five (55.6%) presented recurrent lymphopenia, predominantly with a CD8 <sup>+</sup> T cell decrease.
Dimethyl fumarate has a long-term impact on lymphocyte biology, even after its discontinuation, with a sustained reduction in CD8+ T cells that may increase opportunistic infection risk, and should be taken in consideration when switching therapies after dimethyl fumarate.
Keywords
Dimethyl Fumarate/adverse effects, Female, Humans, Immunosuppressive Agents/adverse effects, Leukopenia, Lymphopenia/chemically induced, Male, Multiple Sclerosis/complications, Multiple Sclerosis/drug therapy, Multiple Sclerosis, Relapsing-Remitting/complications, Retrospective Studies, CD8+ lymphocytes, Dimethyl fumarate, Disease-modifying therapy, Lymphopenia, Multiple sclerosis
Pubmed
Web of science
Create date
07/06/2022 10:40
Last modification date
06/07/2022 6:35
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