Severe multiple sclerosis reactivation during prolonged lymphopenia after dimethyl fumarate discontinuation. (3rd December 2017)

• Record Type: Journal Article
• Authors: Zecca, C.; Antozzi, C. G.; Torri Clerici, V.; Ferrazzini, M.; Mantegazza, R. E.; Rossi, S.; Gobbi, C.
• Is Part Of: Acta neurologica Scandinavica. Volume 137:Number 6(2018)
• Page Start: 623
• Page End: 625
• Publication Date: 2017-12-03
• Subjects: demyelinating diseases -- dimethyl fumarate -- lymphopenia -- multiple sclerosis -- neurodegenerative disorders -- relapse; Neurology -- Periodicals; 616.8
• DOI: 10.1111/ane.12882
• Languages: English
• ISSNs: 0001-6314

Abstract

Abstract : Background: Delayed‐release dimethyl fumarate (DMF) treatment can be associated with reduced lymphocyte and leucocyte counts, which might persist after DMF discontinuation. Case presentation: We report the case of a patient with severe disease reactivation despite prolonged lymphopenia after DMF discontinuation. We describe the frequency and impact of prolonged lymphopenia after DMF discontinuation at two tertiary MS centres. A 36‐year‐old female patient with multiple sclerosis was switched to DMF after 14 years of treatment with interferon beta‐1a. DMF was suspended after 4 months because of persistent lymphopenia for 3 months. Six months later, the patient had a severe relapse with multiple enhancing brain lesions at MRI although lymphopenia was still persistent. Haematological assessment excluded other causes of lymphopenia, which was evaluated as a probable iatrogenic complication of DMF. The patient was treated with i.v. methylprednisolone 1 gr daily for 3 days with clinical recovery. Conclusions: Prolonged lymphopenia after DMT discontinuation does not protect against disease reactivation. Starting a new immune therapy should be balanced against the option of a "wait and see." A different immunotherapeutic strategy such as an anti‐B therapeutic approach could be considered.