ArticleMultiple sclerosis journal - experimental, translational and clinical
Dimethyl fumarate-associated lymphopenia: Risk factors and clinical significance.
Article in Multiple sclerosis journal - experimental, translational and clinical. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
60 citing papers in PubMed, 1 synthesis or guideline pooled it, 111 citations in OpenAlex.
- Disease-modifying therapies and progressive multifocal leukoencephalopathy in multiple sclerosis: A systematic review and meta-analysis.Journal of neuroimmunology · 2021Pooled it
- Effectiveness and safety of cladribine in MS: Real-world experience from two tertiary centres.Multiple sclerosis (Houndmills, Basingstoke, England) · 2022Trial
- Dimethyl fumarate as a versatile therapeutic agent: molecular mechanisms and potential clinical applications.Molecular biology reports · 2026Review
- Natural flavonoids in multiple sclerosis: molecular insights and emerging therapeutic strategies.Frontiers in immunology · 2026Review
- Plasma microRNA Signature as Predictive Marker of Clinical Response to Therapy During Multiple Sclerosis.Annals of clinical and translational neurology · 2025Article
- Impact of Age on Switching or Stopping Disease Modifying Therapies in Multiple Sclerosis.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025Review
- Administration and Monitoring Burden of High-Efficacy Disease-Modifying Therapies for Multiple Sclerosis: A Delphi Consensus of Clinical Experts from Saudi Arabia.Neurology and therapy · 2025Article
- New onset lymphopenia in patients with relapsing multiple sclerosis switching from long-standing dimethyl fumarate treatment to diroximel fumarate: A case series.Multiple sclerosis (Houndmills, Basingstoke, England) · 2024Article
- Frequency of Dimethyl Fumarate-Induced Lymphopenia among Omani Patients with Multiple Sclerosis.Sultan Qaboos University medical journal · 2024Article
- Case report: Primary cytomegalovirus infection in a patient with late onset multiple sclerosis treated with dimethyl fumarate.Frontiers in neurology · 2024Article
- Adenylosuccinic Acid Is a Non-Toxic Small Molecule In Vitro and In Vivo.Pharmaceuticals (Basel, Switzerland) · 2023Article
- Antioxidant Dimethyl Fumarate Temporarily but Not Chronically Improves Intracortical Microelectrode Performance.Micromachines · 2023Article
- Disease Reactivation After Cessation of Disease-Modifying Therapy in Patients With Relapsing-Remitting Multiple Sclerosis.Neurology · 2022Observational
- Article
- Progressive multifocal leukoencephalopathy in dimethyl fumarate-treated multiple sclerosis patients.Multiple sclerosis (Houndmills, Basingstoke, England) · 2022Review
- Diroximel Fumarate as a Novel Oral Immunomodulating Therapy for Relapsing Forms of Multiple Sclerosis: A Review on the Emerging Data.Drug design, development and therapy · 2022Review
- Review
- Effects of disease-modifying therapy on peripheral leukocytes in patients with multiple sclerosis.Journal of neurology · 2021Review
- Monomethyl Fumarate (MMF, Bafiertam) for the Treatment of Relapsing Forms of Multiple Sclerosis (MS).Neurology international · 2021Review
- A Case of Progressive Multifocal Leukoencephalopathy in a Fumaric Acid-Treated Psoriasis Patient With Severe Lymphopenia Among Other Risk Factors.Journal of central nervous system disease · 2021Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
backgroundDimethyl fumarate (DMF), a disease-modifying therapy for multiple sclerosis (MS), causes lymphopenia in a fraction of patients. The clinical significance of this is unknown. Several cases of progressive multifocal leukoencephalopathy in lymphopenic fumarate-treated patients have raised concerns about drug safety. Since lymphocytes contribute to MS pathology, lymphopenia may also be a biomarker for response to the drug.
objectiveThe objective of this manuscript is to evaluate risk factors for DMF-induced lymphopenia and drug failure in a real-world population of MS patients.
methodsWe conducted a retrospective cohort study of 221 patients prescribed DMF at a single academic medical center between March 2013 and February 2015.
resultsGrade 2-3 lymphopenia developed in 17% of the total cohort and did not resolve during DMF treatment. Older age (>55), lower baseline absolute lymphocyte count and recent natalizumab exposure increased the risk of developing moderate to severe lymphopenia while on DMF. Lymphopenia was not predictive of good clinical response or of breakthrough MS activity on DMF.
conclusionsLymphopenia develops in a significant minority of DMF-treated patients, and if grade 2 or worse, is unlikely to resolve while on the drug. Increased vigilance in lymphocyte monitoring and infection awareness is particularly warranted in older patients and those switching from natalizumab.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.