Buckle Guy, Bandari Daniel, Greenstein Jeffrey, Gudesblatt Mark, Khatri Bhupendra, Kita Mariko, Repovic Pavle, Riser Emily, Weinstock-Guttman Bianca, Thrower Ben, Loring Sherrill, Riester Katherine, Everage Nick, Prada Claudia, Koulinska Irene, Mann Monica
Multiple Sclerosis Institute at Shepherd Center, Inc., USA.
Multiple Sclerosis Center of California, USA.
Mult Scler J Exp Transl Clin. 2020 Apr 29;6(2):2055217320918619. doi: 10.1177/2055217320918619. eCollection 2020 Apr-Jun.
In patients treated with dimethyl fumarate, absolute lymphocyte count decline typically occurs during the first year and then plateaus; early drops have been associated with the development of severe prolonged lymphopenia.
We investigated the effect of dimethyl fumarate on absolute lymphocyte counts and CD4+/CD8+ T cells in patients with relapsing-remitting multiple sclerosis treated with dimethyl fumarate in routine practice.
Lymphocyte data were collected via medical chart abstraction. Primary endpoint: change from baseline in absolute lymphocyte count and CD4+/CD8+ counts at 6-month intervals following dimethyl fumarate initiation.
Charts of 483 patients were abstracted and 476 patients included in the analysis. Mean baseline absolute lymphocyte count (2.23 × 10/l) decreased by ∼39% (95% confidence interval: -41.1 to -37.2) by month 6 and 44% (95% confidence interval: -46.6 to -42.1) by month 12. CD4+ and CD8+ T-cell subsets strongly correlated with absolute lymphocyte count, with greater decreases from baseline to 6 months vs 6-12 months, and in CD8+ vs CD4+ T cells. Prior natalizumab was not a risk factor for lymphopenia.
Dimethyl fumarate-associated decline in absolute lymphocyte count in the first 12 months correlated with decline in CD4+ and CD8+ T cells and was independent of prior natalizumab. Absolute lymphocyte count monitoring continues to be an effective strategy to identify patients at risk of prolonged lymphopenia.
在接受富马酸二甲酯治疗的患者中，绝对淋巴细胞计数通常在第一年下降，然后趋于平稳；早期下降与严重持续性淋巴细胞减少的发生有关。
我们在常规实践中研究了富马酸二甲酯对复发缓解型多发性硬化症患者绝对淋巴细胞计数和CD4+/CD8+T细胞的影响。
通过病历摘要收集淋巴细胞数据。主要终点：在开始使用富马酸二甲酯后，每隔6个月绝对淋巴细胞计数和CD4+/CD8+计数相对于基线的变化。
提取了483例患者的病历，476例患者纳入分析。平均基线绝对淋巴细胞计数（2.23×10⁹/L）在第6个月时下降了约39%（95%置信区间：-41.1至-37.2），在第12个月时下降了44%（95%置信区间：-46.6至-42.1）。CD4+和CD8+T细胞亚群与绝对淋巴细胞计数密切相关，从基线到6个月的下降幅度大于6至12个月，且CD8+T细胞的下降幅度大于CD4+T细胞。既往使用那他珠单抗不是淋巴细胞减少的危险因素。
富马酸二甲酯在最初12个月内导致的绝对淋巴细胞计数下降与CD4+和CD8+T细胞的下降相关，且与既往使用那他珠单抗无关。监测绝对淋巴细胞计数仍然是识别有持续性淋巴细胞减少风险患者的有效策略。
