Severe multiple sclerosis reactivation during prolonged lymphopenia after dimethyl fumarate discontinuation.

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.

journal_name

Acta Neurol Scand

authors

Zecca C,Antozzi CG,Torri Clerici V,Ferrazzini M,Mantegazza RE,Rossi S,Gobbi C

doi

10.1111/ane.12882

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

623-625

issue

6

eissn

0001-6314

issn

1600-0404

journal_volume

137

pub_type

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