Research Article| Volume 74, 104699, June 2023

Simple parameters from complete blood count predict lymphopenia, adverse effects and efficacy in people with MS treated with dimethyl fumarate

  • Maria-Elizabeth Baeva
    Departments of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada

    Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Luanne M Metz
    Departments of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada

    Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Jamie Greenfield
    Departments of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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  • Carlos R. Camara-Lemarroy
    Corresponding author at: MS Clinic, FMC and University of Calgary, 1403 29 Street NW, Calgary, Alberta T2N 2T9, Canada.
    Departments of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada

    Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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      • 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.



      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.


      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.


      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.


      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.


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