Highlights
- •Low baseline lymphocyte counts in patients with MS (pwMS) who are on dimethyl fumarate (DMF) is predictive of future lymphopenia.
- •High baseline monocyte counts in pwMS on DMF is predictive of disease activity, including clinical relapse and/or new gadolinium-enhancing lesion on MRI.
- •High baseline eosinophil counts in pwMS on DMF is predictive of common adverse events, such as gastrointestinal dysfunction and flushing.
Abstract
Background
Dimethyl fumarate (DMF) is a first-line oral therapy for relapsing-remitting multiple
sclerosis (RRMS). This retrospective study aims to determine the utility of routine
complete blood counts (CBC) in predicting lymphopenia, adverse effects and efficacy
in a real-world clinical setting.
Methods
The Calgary Multiple Sclerosis (MS) Clinic manages over 1800 people with MS on disease-modifying
therapies (DMT). Data of patients with relapsing-remitting MS (pwMS) who initiated
DMF between July 1, 2013 and December 31, 2014 were included. Patients were followed
for one year. DMT use is carefully monitored and pwMS need a screening CBC and have
regular CBCs done at follow-up. Demographic, clinical, MRI and relapse information
are collected prospectively in a clinic database. We analyzed CBCs at baseline and
month 3.
Results
We identified 139 pwMS in the study period who started DMF. Median follow-up time
on-drug was 12 (0.16–12) months. In our study, 15.8% of pwMS developed lymphopenia
grade 2 or higher. Baseline lymphocyte counts and older age were significant predictors
of lymphopenia. Higher baseline eosinophil counts predicted flushing/gastrointestinal
adverse effects, and higher baseline monocyte counts were predictive of breakthrough
disease activity. Neutrophil and platelet to lymphocyte ratios, markers that have
been associated with overall mortality in the general population, were increased at
month 3.
Conclusions
Routinely obtained CBCs during the screening and monitoring of people with MS starting
DMF offer clinically useful information and generate interesting hypotheses. Age and
baseline lymphocyte counts are reinforced as clinically useful predictors of lymphopenia.
Our novel findings that baseline eosinophil and monocyte counts could offer insights
into usual adverse effects and efficacy, respectively, should be further investigated
as a potentially new set of biomarkers.
Keywords
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Article info
Publication history
Published online: April 02, 2023
Accepted:
April 2,
2023
Received in revised form:
March 28,
2023
Received:
December 18,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
